August 28, 1875.J THE BRITISH MEDICAL JOURNAL.
257
FORTY-THIRD ANNUAL MEETING
OF THE
BRITISH MEDICAL ASSOCIATION.
He/din EDINBURGH, August 3rd, 4th, 5th, and6th, 1875.
PROCEEDINGS OF SECTIONS.
SUBJOINED are abstracts of most of the papers presented to the several
Sections of the Association at the Annual Meeting. The papers
themselves, as opportunities occur, will be published in full in the
JOURNAL.
SECTION B.-SURGERY.
TVednesday, August 4th.
THE Chair was taken by the President, JoSEPH LISTER, Esq., F.R. S.
Demonstration on the Treatment of Club-Foot. By vV. J. LITTLE,
M.D., London.-Dr. Little first alluded to Stromeyer's great discovery
of subcutaneous tenotomy, published in 1831. In 1836, he himself,
by the study of specimens in the museums at Berlin, came to the con-
clusion that contraction of the tendo Achillis was not the only cause
of distortion ; but that the anterior and posterior tibials were also
effective. Accordingly he had, as early as 1837, divided the tendons
of these muscles in cases where it seemed necessary. After showing
how the average age at which patients were operated on had gradually
decreased from eighteen years to a few weeks or even days, Dr. Littlti
went on to consider the causes of imperfect cures or relapses of the
deformity after an apparent cure. These he considered to be the fol-
lowing. I. Omission of operation at an early period. The earlier the
period of operation, the more perfect would be the cure. Operation
might be practised the day after birth. 2. The undue importance
attached to the division of the tenclo Achillis alone. 3. The treatment
by instruments where the patient's foot was kept too long in a fixed po-
sition. By this, the healthy use of the joint was lost. 4. The en-
trusting of the after-treatment too much to attendants, instead of to the
surgeon himself. The excellence of the results would be in proportion
to the amount of personal attention paid by the surgeon. Not a single
day should pass without his reapplying the apparatus. 5. The insuf-
ficient estimate of the difficulties sometimes met with by the operator,
and his consequent neglect to inform the parents of the true nature of the
case. He was in the habit of informing parents that the after-treat-
ment of the case would be required to be attended to by them until
their child had arrived at an age when it was responsible for itself.
6. Improper use of apparatus in those cases where the cure had not
been completed before the patient was able to walk. In relapsed cases,
he deprecated redivision of the tendon, or resection of the muscle itself.
The heroic proposal to divide all the tissues en masse between the skin
and tarsal arch was unnecessary and useless. Even although there was
no risk of bleeding, and though the divided nerves united again, still
there would probably be pain and risk. He had endeavoured from
an early period to simplify the mechanical appliances employed,
whether or not any cutting operation in each particular case be needed.
During the last ten years, he had gradually advanced to the present
state of his experience that every case of congenital varus in an infant
under nine or ten months of age requires absolutely no other me-
chanical appliances than a roller bandage and one or more padded
metallic splints successfully adapted to the limb, in proportion as its
form and position improve, and that more elaborate apparatus based
upon Scarpa's or Stromeyer's modified Scarpa's shoe, or upon steel and
India-rubber springs, with leg-irons, is only required when either ill-
fortune, inattention, or neglect has prevented the treatment from being
carried out early or in a thorough manner. He laid clown the follow-
ing rules. Whether or not any division of tendons be deemed neces-
sary, commence the treatment at the earliest ·period the health of the
infant, the state of the mother, and other circumstances, permit, even
within twenty-four hours or the first week of birth. If in douht as
to need of operation, "take farther advice'', or try gentle mechanical
treatment only, by means of his splints, for a few weeks. 'Vhether or
not any operation be performed, remove and reapply the splint at
least once in each twenty-four hours, and whenever it appears to be
seriously displaced. Practise and teach the nurse to effect, daily
or oftener, gentle manipulations, pressings and stretchings of the
distorted parts towards the desired form and position, and guard
against the ankle losing any portion of its natural movement ; over-
come thoroughly the inversion of the foot and the contraction of the
sole before attempting to bring down the heel, especially if resort be
had to operation. However favourably the case may progress, do not
permit the part to assume for a moment any portion of the former evil
position, from which the treatment may have gradually rescued it, or
allow the child on any pretence to he placed on the foot before full
natural eversion and bending can be readily effected by the attendant
and anatomically or spontaneously by the child. A well treated suc-
cessful case of severe congenital varus can apply the sole and heel pro-
perly to the ground with the toes turned out, and walk at the age
of twelve to sixteen months as well as a sound child. In conclusion, Dr.
Little showed how he considered a cure of club· foot could be effected be-
fore the child was twelve months old, so that not only should the foot be
perfect in shape, but also in function. This consisted in the applica-
tion of a well-padded straight splint, at first exactly moulded to the de-
formity. Gradually, each clay, the angle was to be changed, until the
foot, from the position of varus, assumed that of valgus. It should
be kept at this for a few clays. vVhile this process was going on, the
movement of the foot at the ankle should be performed each day. If
necessary, the tendo Achillis might be divided, and a splint with a
screw used. By this means, the surgeon could, in twelve months, obtain
a perfect cure, and thus avoid all unnecessary expense to the parents,
or annoyance to the patient. The author exhibited a series of his splints
for the cure of congenital club-foot in infants, and of other apparatus,
for incompletely cured, relapsed, and neglected cases, employed from
the time of Scarpa to the present clay.
President's Address.-The PRESIDENT delivered an address.
1Vote on a Peculiar Variety of I.f;,drocele of the Cord. By FuRNEAUX
JORDAN, F.R.C.S.Eng., Birmingham.-A young gentleman, aged 23,
presented himself with an enlargement in the scrotum, a little larger
than a walnut, spherical, and well defined, situated midway between
the external ring and the testis. The cord was distinctly felt above the
swelling, but slightly thickened. The enlargement was translucent, was
very movable, was a little larger in the evening, and a little less in the
morning. There was an impulse on coughing, at which time a fine
rustling stream of fluid could be felt passing through a second tube
from the abdomen to the enlargement. 'Vhen firm and persistent
pressure was a made, a stream of similar character could be felt passing
from the swelling to the abdomen. There was at no time any sign of
protruding bowel. Mr. Jordan believed that, in its anatomical cha-
racters, and in its mode of formation, the enlargement was similar to
the "encysted hydrocele of the cord", except that a fine tubular com-
munication with the abdomen still remained unobliterated. The treat-
ment recommended was a light truss, to cut off the communication with
the abclomen.-Mr. RIVINGTON (London) took exception to the nomen-
clature of the case. It was not an encysted hydrocele of the cord, be-
cause it seemed to communicate with the peritoneal sac. It looked
like one of the varieties of congenital hydrocele of the cord.-Mr. 0.
PE)!DERTON (Birmingham) thought it was simply a portion of peri-
toneum containing peritoneal fluid, to which the term hyclrocele did
not apply. Puncture would have led to a communication with the
peritoneal sac.-The PRESIDENT thought that it might be diffused hy-
clrocele of the cord where there was fluid in its cellular tissue, commu-
nicating with the cellular tissue of the iliac fossa. It thus could be
induced with difficulty; and, when the patient stood up, a rushing
sound was heard from the fluid making its way back. He thought
that it was a misnomer to call it congenital hydrocele, as the tube
opened into the peritoneum.-Dr. PmRm (Aberdeen) thought that the
case was analogous to one he had met with. In it, there was nothing
in the scrotum ; but two little tumours could be felt in the cord. They
did not communicate with one another ; nor did the upper one open
into the peritoneum. He therefore believed them to be two hyclro-
eeles of the cord, clue to the irregular contraction of the tubular prolonga-
tions. He thus held that there was an accumulation of fluid before
closure. They differed from Mr. Jordan's case in having no commu-
nication with the peritoneum.-Mr. F. JORDAN was afraid he had been
less distinct in his paper than desirable. In the programme it was
described as hydrocele of the cord.-Mr. RIVINGTON objected to the
term "encysted".
Excision of the Th)'roid Gland. By P. HERON WATSON, M.D., Edin-
burgh.-Dr. vVatson noticed the opinions of surgical authorities on the
subject, and described five cases in which he had operated, one of them
being fatal. He recommended attention .to the following particulars.
I. The external incision should extend from the larynx to the sternum,
if the tumour be large and spread widely in a lateral direction. 2. The
vessels-arteries and veins-should be secured as they are divided. 3.
The fascia should be opened as widely as the skin; and, if the tumour
be large, the soft parts may be divided transversely as far as the sterno-
mastoicl muscles. 4. The delicate investing fascial sheath of the thyroid
body should be left undivided until the vessels included in it have been
tied. 5. After the mediate ligature of the thyroidal vessels in the eel-
 258 THE BRITISH MEDICAL 'JOURNAL
lular sheath, the capsule of the thyroid gland should be openecl by
stretching through it in the middle line, and the attachments of the
goitre carefully divided by blunt-pointed scissors curved on the flat.
There shouhl be no tearing away of the gland. 6. If bleeding occur
after the separation of the tumour, from any of its vascular attach-
ments, the vessels, if they are to be secured, should be tied
e1t 111asse along with the cellular sheath.-Mr. LENNOX BROWNE
(London) felt that the operation for goitre was one of which
he coul•l not apprO\·e, simply because it was unnecessary. In
none of the cases dicl there seem to be dysphagia or difficulty in
breathing. The fir,t case was typical, viz., a young lady with a goitre
about the size of a China orange. When an incision was made from
the larynx to the sternum, the cicatrix caused a worse deformity than
the goitre itself. But there were other means of removing the gland
equally certain, and leaving no mark. There were four varieties of
goitre, Yiz., simpl.c, fibroid, cystic, and fibro-cystic. In the simple,
counterirritation by the reel iodide of mercury was sufficient. In the
fibroid, injection of iodine into the substance of the gland produced
.most \rnnderlul results, without any resulting deformity. In the cystic,
'ne used tu inject iocline. IIe now, however, tapped, injected with
perchluricle of iron, and plugged the cannula. In about forty or fifty
cases, there had been only one death. In the fibro-cystic form, setons
were of great value ; or J\faisonneuve's darts of chloride of zinc might
be usecl. Ile therefore lielieYed that the operation was unnecessary;
and, although it \\'as lirilliant enough, it was better to try milder
measure_..;, rc1nembcring the aphorism of llippocrates, viz., "to cure
the patient with as little harm as possihle".-The PRESIDENT said
that he hacl only seen Dr. \Vatson's unsuccessful case. The principle,
however, seemed a sound one. An improvement he had made was
to sulxlivicle the part ligatured, and ligature each half. The larger the
tumour was, the gre'1ter the risk. If it were large and overlapped the
carotid sheath, it \\'as important to tie the tissues with the vessels at such
distance that, when the fascia! sheath was divided, there should be no
risk of hxmorrhage from the ligature slipping. lie therefore passed an
aneurism-necdle from the middle to the side, and divided the ligature.
He next passed a needle along one of the threads, and, pushing it
through the tissues, cut the thread. He then withdrew the needle, and
ied the ligatures. The gland could then be dissected out without
blcecling. In the first case, the gland enveloped the trachea, and
overlappecl the carotid sheath. The second was extremely vascular,
was principally on one side, and largely overlapped the carotid vessels.
One vein, during the operation, was so large as to look like the in-
ternal jugular. The operations were performed antiseptically. There
was no suppuration in one case, and only a little tension in the other.
IIcmp was used for the thyroid vessels, as the catgut was hardly strong
enough. Dr. Thomas Keith, however, had shown him some, kept for
five years, which was exceedingly strong, and, by twisting it in strands,
it cott!d l>c used for any purpose. In both the cases operated on there
was severe clyspncea.-Dr. \VATSON said that, perhaps, he clid not go
into symptoms sufficiently, so as to settle, to the satisfaction of some,
the propriety of operating. In all his cases, there were difficulty in
deglutition, striclor of breathing, and affection of the general health.
The operations were certainly not undertaken as a dernier i-t"ssort, just
as it was not the custom in tracheotomy to operate at as late a period
as possible. In goitre, if they waited until the patient was suffocating,
there would be a ri,k, not only of disfigurement, bnt of death. The dis-
figurement \\"aS large when the incision was made; but, even after
twenty-four hours, there was great contraction. In one case, an inci-
sion of seven inches contracted to an inch and a half. In regard to
Maisonneuvc'sj71'chts, he hacl heard of a case where the incision for their
introduction was followed by severe bleeding. This was arrested by
lint strips. After the separation of each slough, bleeding also took
place ; so that the patient was in great danger, and ultimately re-
covered, \\'ith various cicatrices, to which no linear one could be com-
pared. Ile had employed injection with iodine in many cases without
admirable results. In cystic goitre, whether unilocular or multilocular,
he woulcl not operate until he had tried tapping. In all his cases he
had clone so. In his first, he had tapped and injected ; but other cysts
appeared. Ile therefore deemed it inexpedient to wait and operate as
a dernier rtssort. In the cases operated on, both his colleagues and
himself \\'ere satisfied as to the necessity of operation.
A Cast' in 7i1!1ich _;/J,1111s's Operation for Subcutaneous Division of the
.L\'t·ck of t/12 Thig!z-bon<' was performed on Both Sides in the smne Patient
)or Strai;;ht Ank;<losis. By EDWARD LUND, F.R.C.S.Eng., Man-
chester.-ln the case related by Mr. Lund, both hip-joints were anky-
losed in the straight position, so that the patient could not sit down.
Subcutaneous division of the neck of the thigh-bone was first performed
on the left side, and twelve weeks afterwards on the right side. The
result of the operation was, that the patient acquired excellent power
[August 28, 187 5.
of motion in both hips; he could support the weight of his body
on either leg; and he had greatly improved in all respects.-Mr.
WILLIAM ADAMS (London) felt sure that no one could congratulate Mr.
Lund more than himself in having been so fortunate as to obtain useful
mobility at both points. He had aimed at such results, but without
getting them. In his own cases, there had been extreme deformity,
where motion could not be obtained even when the patient was under
chloroform. In about twelve or fifteen cases now operated on, there
had been only one failure, and it was in St. Thomas's Hospital, where
the patient was a stnunous child, with little ankylosis. As a rule, the
cases to be operated on were, beginning with the best, rheumatic,
py::cmic, traumatic, and scrofulous. The last should be excluded. If
the cases were carefully selected, the results would be good. Mr.
Bryant had operated on two cases, with successful results.
Two Cases of Anmrism, o·ze of the Carotid and one oj the FemoraJ
Artl'IJ', trMtai by the TVire Compress. By J. Drx, J\I.R.C.S.Eng., Hull.-
The wire compress here spoken of was introclucecl to the profession by
Mr. Dix ten years ago, as a substitute for the ligature. The full de-
tails of the methocl, with illustrative cases, were published in the 1''din-
bzo:r;h llionth~y :Journal for September 1864. At that time, he had
onlv used it for wounded blood-vessels; but he also spoke of its appli-
cability to arteries in their continuity, and explained the process for
aneurism. He now related two cases in which it was so used on the
carotid and on the femoral artery. Both were successful. In the
latter, the incision, five inches long and an inch and a half deep, healed
by first intention. The operation is as follows. The artery is cut
down on, and the wire is drawn under the artery by the aneurism -
needle in the usual way. Each end of the wire is then attached to a
needle, and so brought out through the tissues by the side of, but clear
of the wound, so that the ends are about half an inch from each other.
A piece of cork is placed between the points of exit of the wire, and
pressed firmly down in the course of the artery; and over this the wire
is tightly twisted till the circulation is stopped. In each of the cases
related, a feeble current of blood was admitted into the sac for three
days, and only on the fourth day was it entirely cut off. In twenty-
four hours afterwards, consolidation of the aneurism had taken place.
The wire is removable at any time, and in these cases was removed on
the sixth and seventh days. 'This the author considered one of the
greatest advantages of his method, as it allows the gradual establish-
ment of the collateral circulation, and greatly diminishes the risk of
gangrene, if not removing it altogether. It does not cut the inner
coats of the artery, nor cause ulceration of its outer coat; its blood-
channel is intact, and h::emorrhage cannot possibly occur. Bleeding
(the greatest danger from ligature) is entirely abolished; and gangrene,
the next most fatal risk, is much diminished. The wire compress has
other advantages over the ligature. Thus it is not a foreign body in
the wound, and therefore does not excite suppuration and impede
breathing. It is applicable to all arteries alike.-Dr. PIRRIE (Aber-
deen) said that a great deal had been brought forward on acupressure.
Since 1854, he bad used no other method of arresting huemorrhage in
any operation, unless in those on the tongue, upper jaw, and deep
tumours of neck. His belief in it was unshaken; and acupressure,
defined as "metallic compression, removable at pleasure", he believed
to be one of the greatest improvements in modern surgery. In regard·
to its use in aneurism, there was no time to discuss it, although he
would have been most happy to do so.
On tht Jliodtrn Trmt111mt ef the Advanced Stages of Co11stit11tio11a!
Syp!1i!is. By WILLIA~! ACTON, J\1.R.C.S.Eng., London.---The
author spoke of the ravages produced in syphilitic patients in the time
when it was the custom to administer mercury in excess, and to
the reaction against this practice in the form of the so-called expectant
treatment. He then gave an exposition of Ricord's views on the
treatment of syphilis; and enunciated the following laws as those
which should guide the practitioner in the management of the disease :
-r. That mercury is most successful in the treatment of secondary
symptoms ; 2. That iodide of potassiui;n is to be princi.pally d.epend~d
on in tertiary symptoms; 3. That a mixed treatment 1s applicable 111
cases of advanced constitutional syphilis. In conclusion, he made some
remarks on the necessity of preventing syj)hilis, and described the re·
suit of observations which he had made on prostitution in Edinburgh,
where he found the evil to prevail to an excessive extent.
Tracheotomy in Croup and Diphtheria. By GEORGE BUCHANAN,
M.A., M.D., Glasgow.-This paper contained an argument for ope-
rating on the suffocative stage and type of the above diseases founded
on Dr. Buchanan's own experience, which was summarised as follows:
total cases of tracheotomy in croup and diphtheria 46, cured l 7, died
29; croup 16 cases, cured 6, died lO; diphtheria 30 cases, cured l l,
died 19.
 August 28, 1875.) THE BRITISH MEDICAL '70URNAL.
The Treatment of Patent Urachus. By J. J. CHARLES, M.D.,
Belfast.
Case of Perforation of the Abdomen per Vaginam; with Remarks.
By ALEXANJlER E. l\lcRAE, M.D., Penicuick.
A Case of Partial Rupture of the Poplittal Arte1:1•, a11d Complete
Rupture of the l\pliteal Vein, for whicli Primary Amputation of the
Th~l{'lz was performed. Hy \V. RrnNGTON, F.R.C.S.Eng., London.
-The patient was a healthy young man, aged 19, who was riding
on the front seat of an omnibus, when a runaway horse and cart dashed
at the omnibus, and a corner of the cover of the cart struck him on the
left knee, driving it forcibly backwards. On his admission into the
London Hospital soon after the accident, there was much contusion of
the knee, but no signs of fracture or dislocation. The swelling of the
part increased, and the patient complained of loss of sensation in the·
leg; the temperature of the limb also fell. Pulsation could be barely
felt in the posterior tibir,l artery. On auscultation, a low clicking
sound was heard in the course of the popliteal artery; and the dia-
gnosis formed was probable rupture of the artery. This diagnosis was
concurred in the next day by Mr. Hutchinson; and amputation was
performed by a modification of Teale's operation. The patient ulti-
mately did well. On examination, there was found to be extensive
effusion c,f blood in the areolar tis-ue of the limb. The posterior liga-
ment of the knee-joint ,·.-as slightly torn; ancl the plantaris muscle
was torn from its atlach1ucnt to the femur. The popliteal vein was
complet<:ly scvcrecl; and the inner and middle coats of the artery were
separated from the external. The ligamentons and cartilaginous struc-
tures of the joint were injmctl ; m;cl the external conclyle of the femur
was nearly scparatccl by a fissure, "·bile a small triangular piece of
hone lay loose and pwjectecl into the joint. The upper part of the
tibia was also fissured. The history of the case was followed hy some
practical comments.
Dm1011stratio11 Oil Stridure of the Ur,•thra. By F. N. Ons, ]\f. D.,
New York.-Dr. Otis saicl that a stricture of the urethra might be
caused by any inflammation which spread below the mucous membrane
so as to cause a deposit of tissue in the submucous coat, and conse-
quent obstruction of the· calibre of the canal. This obstruction might
vary from a slight constriction to complete obliteration. By some, it
was considered that where a No. 8 or 9 instrument of the English scale
passed, there could be no stricture. This he considered entirely
wrong. By means of his urethrometer, he was enabled to ascertain
the calibre of the urethra. In a series of about five hundred cases, he
had established the fact that there was a constant relation between the
circumference of the flaccid organ and that of the urethra itself. He
went on to show how the slightest constriction of the urethra procluced
friction ; and that this, leading to irritation, causecl, when it became
chronic, gleet. Gieet he considered as the indication of a stricture.
There mi!(ht be, of course, stricture without gleet. His plan was to
dilate the urethra, after ascertaining its calibre ancl the position of the
stricture. The dilatation \Yas to he carried at least two degrees beyond
the ascertained normal calibre of the canal. Hy means of a fine knife
two milliml!trcs in hreaclth, the stricture was then divicled internally.
By this means, it could also be ascertained accurately whether there were
more than one stricture, so that they could be dealt with in the same
n1anner.
Demonstration of Co11j1111rtiz•al Tra11spla11tation from the Nab/lit t,1 the
/Juman Su!yi·d. By J. R. \VOLFE, l\f.D., Glasgow.-1.lr. \Volfc first
described the nature of the affection in which this transplantation was
necessary; viz., in aclhesions between the apposed surfaces of the con-
junctiva due to injury. Previous attempts to remedy this had been
mechanical, and therefore useless. In I8j2, he deviser\ this method of
transplantation; am! it was now practised by Becker, Von Graefe, and
other,. Vctails as lo how it \\'as done were, therefore, needed. Two
patients whom he liacl under treatment were shown. r. F. B., aged 9,
hacl his right eye burnecl with lime in January la>t, the cornea being
rendered almost entirely opaque, \Yith the exception of the small upper
and outer segment. The l•upil was thus completely coYcred with the
adherent lower eyelid. Dr. \Volfe fin;t turned the tramparent prntion
of the cornea to account hy making an artificial pupil upwards and out-
wards. Eight days ago, he operated for the cure of the symh!cpharon.
Some of the ligatures were >till in the new conjunctiva from the rabbit,
2. Peter C., aged 20, a quarryman, was operated on on January 23nl,
1873. The patient harl his face and both eyes injured from a gun-
powder explosion .. His left eye was completely blinded by a :;ymble-
pharon. 1Jr. \Volfc made an iridectomy upwards, and then remedied
the symblepl1aron fiom tl:c conjunctiva of the rahbit. A fortnight ago,
he presented himself again for the treatment of his everterl eyelid of the
right eye, when Dr. Wolfe found that a small bridge had formed in the
new conjunctiva, which he separated, and $Upplied a new conjunctiva]
flap.
259
Thursday, August 5th.
On Ligature of the Common Femoral Arte1y; and especially on Liga-
ture by an Antiseptic hfaterial. By OLIVER PEMBERTON, F. R. C. S.Ed.,
Birmingham.-Mr. Pemberton began by referring to a case described
by him in his Address on Surgery at the meeting of the Association in
1873, in which, as he then supposed, he tied the common femoral
artery for an aneurism in Scarpa's space. The operation was successful
as regarded the main issue ; but, the patient having since died from
another cause, Mr. Pemberton had found that the circumflex ilii, the
epigastric, and the profunda femoris arteries, were given off together
above Pou part's ligament; and that he had tied the superficial femoral
artery. The portion of vessel (five-eighths of an inch) between the
point of ligature and the origin of the above-named branches was
firmly plugged. He then went on to argue that it was the surgeon's
duty in such cases to tie the common femoral artery in preference to
the common iliac; because it produced less danger to the patient, and
because there was yet an artery left to tie in case of failure. He did
not regard the risk of secondary h::emorrhage, insisted on by Mr.
Erichsen, an objection to the ligature of the common femoral; and he
believed that this risk might be diminished or even removed by the use
of an antiseptic catgut ligature, applied in such a way as to close the
artery without cutting it through. He believed that the objection as to
the point of origin of the profunda was of no real importance if the
vessel were not cut through.-1\Ir. Lt:l'm (Manchester) wished lo
know when the hempen ligature came away, and whether it was
clrawn through, showing that there had been divbion of the artery. In
the other case, did the ligature undergo solution, or remain as a
fibrous band ?-1\lr. 1'1·::,IHERTON said that the hempen ligature came
a1rny thirty clays after operation. As the loop of whipcord "·as intact, it
must undoubtedly have cut its way through the tissues of the vessel.-
1\fr. Drx (Hull) said that it "·as remarkable, he thought, that the
artery he mentioned in his paper read on the previous day as not being
ligatured for fear of secondary h::emorrhage, was the common femoral.
The point on which he wished most particularly to dwell was the com-
parison of the catgut ligature with his own method by means of the
wire compress. The advantages of the catgut ligature were, he
thought: r, that it was not a foreign body; 2, that it did not damage
the internal coats; 3, that it did not require to be detached by ulcera-
tion as in the case of the silk ligature. It, however, might give way
too soon; and in one case the clot had been carried to the brain on the
second day. But by his method the wire could not yield too soon, nor
become detached. Above all, the circulation was not cut off too
quickly. The circulation was at first feeble, allowing deposition of
lymph. Then, when the wire was tightened, the clot was completely con-
solidated. The wire could then be taken away without fear of secondary
hremorrhage.-1\fr. RIVIXGTON (London) asked how Mr. Dix was sure
that the wire did not cut through the vessel. -Mr. Drx said that, in
the case of carotid aneurism, there was pulsation when the wire was re-
moved.--l\Ir. FURNEAUX JORDAN (Birmingham) congratulated Mr
Pemberton on his paper. At St. Bartholomew's Hospital, he had seen
Sir James Paget apply a ligature to the common femoral in a stump
where there was bleeding clue to sloughing.-Dr. PIRRIE (Aberdeen)
thought that their present experience did not warrant them in giving a
definite opinion on the merits of acupressure and the catgut ligature.
Everyone knew that from limited statistics any conclusions could be
drawn. It was their present duty to collect facts. There was a
remarkable unanimity among the members of the profession in regard
to ligature of the common femoral being undesirable; while that ol the
external iliac was highly successful.-1\ir. LISTER (Edinburgh) ditl not
suppose that Mr. Pemberton meant that a hempen ligature would be
without risk when applied on an arterial trunk near a large branch.
The origin of the branches of the common femoral varied extremely;
and it macle all the difference, \Yhether the ligature was applied cloee
to a large branch or a quarter of an inch above it. As to the catgut
ligature not cutting through the internal an<! middle coat,, he always
applied it so as to clo so. At his antiseptic demonstration, he had
pointed out how the ligature was not properly prepared, as his own
directions were wrong. Ile hacl prepared it rightly himself; but it was
by accident. The catgut ligature, when rightly prepared, could be
used without risk. lle had tictl the femoral artery four times, aud the
carotid once with it, succc"fully; and his colleague Mr. Annandalc
had had the same experience with regard to the femoral, the carotid,
and the external iliac. In none of these cases had there been any
giving way.-'.\Ir. l'E1U:ERTON, in reply, said that in his first case
there was an abiding eoagulum; and in the second, where he had tied
the artery one inch below Pou part's ligament, there was no severance of
the lube of the artery. Ligature of the external iliac was successful;
but Mr. Lister should not forget cases where the aneurism recurred. It
 THE BRITISH MEDICAL JOURNAL.
certainly was not good l<l have recurrence, or to tie the artery again
above the former ligature.
On a _. _ \~·w O;\:rrl//on j!w tl1t• Ohlitr:ration of /J,'j>rtssc'd Cil«Tlriccs af!t'r
C!1111d11/,1r .·lbsc,·s.<'<'s or Fxfuliatiull of Holle. By \VILLIA:-r ADA:11s,
F. R. C. S. Eng., I .onclon.-The operation consists of the following steps:
I. Subcutaneothly <livicling all the deep adhesions of the cicatrix by a
tenotomy-knife intruducecl a little beyoncl the margin of the cicatrix,
arnl carriecl do\\'n to ih base: 2. Carefully and thoro,1ghly everting
the <leprcs:::.cd cicatrix, turning it, as it were, inside out, so that the
cicatricial tissue remains prominently rnised: 3. Passing two hare-lip
pins or finer neeclles through the base, at right angles to each other, so
a;; to 1naintain the cicatrix in ih everlccl and raised fonn for three day:-;:
4. l{emoving the needles on the thin! <lay, ancl allowing the cicatricial
tissue, now somewhat swo!len, succulent, and infiltrated, gra<lually to
fall do\\'n to the proper level of the surrounding skin. Three cases, in
\\'hich this ope;·ation hat! been performed by i\Ir. Adams, at periods
varying from eleven, nine, an<! three years from the present date
\\'ere acklucccl in illttotration. In the last t\\'O cases t!escribed,
one resulting from glandular abscesses in the neck, arnl the other
from necrosis of the inferior maxillary hone, all traces of the de-
pression \\'ere removed, am! the cicatricial tissue albne coul,J he seen;
hut it was perfectly on a level with the "nTounding skin. Jn texture
ancl in appearance this cicatricial tissue had so much improved, having
lost it::; shinv, 1nen1hr_111ous and Yascular character, and become
thickened ancl of an opa<i"C "·hite colou;" that it closely resemhlecl the
sctrrouncling skin. In the first case, which had resultccl from a lrnl!el-
'"'Hlnd, and a portion of the mcilar bone hacl been carried away, al-
though the deprc5'ion could not be entirely obliterated, very great im-
provement had rcsnlterl from the operation. The permanency of the
operation \\'as placecl bcyol1ll all doubt by the two last cases described, one
nine, and the other nearly three years since the operation ; and the
completeness of the obliteration of the <lepression ; and the improve-
ment of the cicatricial tissue surpassed l\Ir. Adams' most sanguine
expectations.-:\lr. Ll:~D (~fand1ester) had a case some time ago in a
young gentleman who losl a portion of the bone below the orbit, a de-
pressed cicatrix being left. IIe had operated without i\Ir. Adams's im-
provements ; and, when he saw the case last, the cicatrix had fallen back
to its old state. The patient wished to be again operated on; and,
although he was un\\'illing then to do so, yet he might with Mr.
Adams's needles give him a further chance. He would like to know
what dressing i\Ir. Adams used. He thought that, in such cases, the
cavity might be nicely filled up with blood-clot, the uses of which they
had seen in Mr. Lister's demonstration. It would be important to pre-
vent suppuration in the line of the needles.-:\! r. A1l.\:-1s did nol use
any dressing except collodion in one instance. In only cne case
hacl he any blee<ling. The needles were removed on the third clay,
with a little suppuration in one case, but none in the others. The
only difficulty he had was in avoiding veins.-Dr. HARDIE (Man-
che.<ler) had founcl a difficulty in operating on depresse<l cicatrix by one
puncture. At '.\Ir. Adams's suggestion, he had so treated a case of
depressed cicatrix over the maim· bone large enough to admit the
little finger. It hatl been unsuccessful; and he had, therefore, clis-
sectetl the cicatrix out, arnl by wire sutures brought the edges together.
A small linear cicatrix only remained after three years ; and there was
no recurrence as in i\Ir. Lund's case.-Mr. A:'iNANDALE (Edinburgh)
had listened \\'ith great pleasure to the paper. i\Ir. Adams had been
very successful in his two cases. From his own experience, he shouhl
have hesitate<! to interfere with the cicatrices so freely, from fear of
sloughing. ] t was interesting and curious th:-tt, in l\Ir. Aclan1s's cases,
there \Yere no such bacl results. On the \\'hole, he preferred i\lr.
IIardie's method, if it did not remove too much.-:\Ir. L!STER thought
that the plan \\'as undoubtedly ingenimh ; and there could be no harm
done if, in the cli~section, no veins were wounded. The operation was
sul>cutaneous, and the pins pressed on sound tissue. Experience woulcl
shcrn· if the cure \\·ere permanent. He himself woultl prefer to dissect
out the skin, and, u~ing button-sutures, get pri1nary union with a linear
cicatrix.-Mr. A1i.1~1s ha<l cut nut lhe crcatrix in one of his cases.
There "·as neces:;arily, however, a scar.-i\lr. LISTI<R did not quite
undcrstarnl how there \\',1s no scar in :\I r. Adams's cases. IIe thought
there must lie an improve,] scar.--1\!r. AD.UtS explained that the scar
became thicker and Jess conspicuous, because more like the surrounding
texture::.:.
A A::cc1 Rhinojl11s!it Ofcmtie11. By J. IL1RDIE, l\L D., :\fanchesler.--
Dr. I lanlie read a paper on a case uf loss of nose, for which he ha<l devisecl
a ne\\' operation. The patient \\·as a girl aged sixteen, \\'ho hatl lost her
nose in early childhood, from disease. The whole of the organ had been
de.;lroyed, with the exception of small portions of both ahc and of the
columna, ancl the m:ugin of the resulting cavity was covered hy thin
while cicalricial tissue. The principal difficulty to be overcome was
[August 28, 1875.
that of securing sufficient prominence to the new substitute. It was
evident that if the latter consisted of soft parts alone, it would in a
short time become nothing more than a mere covering over the cavity :
it was therefore necessary to provide a bony support for the superstruc-
ture of soft parts. It was thought that this encl might have been at-
tained by partially detaching the nasal process of each superior maxilla,
and connecting them in the middle line. On further reflection, how-
ever, this method was discarded, as it appeared unlikely lh~t a suffi-
ciently long piece of bone could be obtained to serve instead of both
hones arnl cartilages. It was then cleterminetl to en<leavour to utilise
a portion of one of the patient's fingers for the encl in view. Accord-
ingly, an incision was made along the middle of the palmar surface of
the last phalanx of the left forefinger, \\'ith a transverse incision at its
base. Two flaps of skin were then raised, one al each side of the finger.
These were then stitched to the previously denudecl margins of the
cavity, antl the arm was carefully supported by means of long strips of
adhesive plaster passed round the neck and under the elbow. Union
took place on one side by adhesion, on the other by granulation. The
arm was retained in its position for the periotl of three months, in onler
to secure a complete vascular supply from the face to the finger. llivi-
sion of the finger was accomplishe<l gradually, with the same ernl in
view; and \\'hen the bone \Vas divided \\'ith the bonc·pliers, effecting
complete separation, both ends of it bled. The patient die! not suffer
from the prolonged constraint. The transplanted phalanx re tainecl its
vitality unimpaired. Further operative details \Vere subsequently had
recourse to to unite the alx and columna with the free en<l of the finger,
and to remove the nail. \Vhen these steps were completed, the trans-
planted finger itself presented a very fair substitute for the nose; but in
the course of a few weeks it had receded to some extent into the cavity,
so that il would still be necessary to carry out the original intention of
covering it with a portion of skin. It was thought, hO\vever, that, in
suitable cases, the finger itself might be used to form an adventitious nose
without further covering. In the event of the operation being again
undertaken, it was recommended to use a longer portion than one
phalanx, to adopt means for narrowing the orifice of the cavity, and to
be careful that the finger did not become twisted from a perpendicular
line during the process of union.
On the Treatment of Stnmwus En!a1;~c111m!s of the Glands by I!j,p,1-
d<'rmic I11jectio11s. By MORELL MACKE='IZIE, M. D., London.--The
author 'commenced by stating that his paper had reference principally to
disease of the cervical glands, for it was in that situation that it was
most important to get rid of the enlargement without disfigurement.
Practitioners had always found great difficulties in dealing with these
cases, as treatment often exaggerated the deformity. The author staled
that, as the results of his experiments with many different solutions,
he had found the dilute acetic acid the most valuable remecly. As a
rule, he injected once a week; but, where several glands \\'ere affectecl,
the injections could be made more frequently. It was desirable, if
possible, to cure by absorption; but sometimes suppuration coul<l not
be prevented. In these cases, the pus should be drawn off by a fine
aspirator. Suppuration was apt to ~e followed by thickening of the
walls or outer portion of the glands. In these cases, the oleate of mer-
cury (ten per cent.) was most valuable. The author then proceeded to
quote in detail some of the thirty-six cases which he had treated with
acetic acid. He concluded by stating that he did nqt believe that the
cure of these cases rendered the patient more liable to phthisis. He
had seen many cases of phthisis develope where glandular enlargements
had existed untreated; but he knew of none where pulmonary disease
had followed the cure of such cases. On the other hand, he thought
that phthisis was more likely to follow the spontaneous breaking down
of glandular tissue.
Two Cases of Punctured J•}·acture of the i'i·ontal Bone treated by
Trc.fhining _; and resulting, one in f(1ta!, tht' (J/her in flu-fial, Loss of
Vision. By Km.HURNE KING, l\I.D., F. R.C.S., Hull.- In the first case,
the acciclent arose from the kick of a horse in the left sick of the foreheacl.
A punctured fracture of the hone was the result. For some time, no
serious symptoms arose. But, a month after the accident, Dr. King
trephined the bone, on account of head-symptoms, arnl removed three
portions of the internal plate of the skull which projected through the
membranes into the substance of the brain. Abscess and hernia cerchri
followed; but eventually the patient recoverecl, with, however, loss of
vision from atrophy of both optic nerve,;. The seconcl case \\'as that of
a sailor, who fell into the hold of a ship, and received, among other
injuries, a punctured fracture of the left side of the forehead. Three
weeks after the accident, Dr. King trephinecl the patient. N otwith-
standing this, a most serious train of symptoms set in, including para-
lysis of all the limbs, except the left arm; hyper::csthesia of the· legs ;
blindness, deafness, loss of speech, and delirium. This patient ever. lu-
ally recovered, with blindness of the right eye, caused by atrophy of
 August 28, 187 5.J THE BRITISH MEDICAL JOURNAL.
the optic 10erve.-Mr. NA!'l'ER (Cranleigh) said that, as the result of
experience of two cases, he believed that trcphining, though easy at the
time, yet presented after-clitiiculties. In one case, suppuration occurreel
unclcr the clura metier, and the patient dicel. In a similar case, he \\"Otild
not hesitate to make free incisiom.-l\lr. \V. An.\~IS (Lom\011) felt
clouhtful as to \\·hether the fractures should have been termed punc·
lured. They were rather clcpre"er\ ancl comminutccl. l'uncturccl frac-
tures were produccc! by a spike, pitchfork, hetyonet, etc., but not liy the
tick of et horsc.-:\Ir. LlsTER (Eclinlmrgh) remetrkccl on the interest
of the cases. The double vision with one eye \Yas Ycry remarkable.
The practical lesson \rns to show the importance of Syme's rule of trc-
pliining in such ca~es, without waiting for sympto1ns. As to the tcrmi~
nology, if a fracture were causecl liy great violence, and the external hole
\\·ere small, it coulel be terrneel punctured. It was unnecessary, ho\\·-
c\cr, lo stick loo closely lo lcrms.--Dr. KING said there \\·oulcl he
some hesitation in lrephining a lac! who rode two miles for achicc after
the :tcciclent. As the result of his experience, ho\Yevcr, he thought it
\mule\ be goo,] to trephine in all cases of punctured fracture. In reganl
lc1 whether it shoulcl be termed a punclureel or depressed fracture, it
\\"as really a mat tu of fact; and he should therefore ha Ye brought the
s1•ccirncns with him. All the mischief \rns caused lJy the splintering of
the inner tethle, and he thought puncturerl fracture a good name.
Ct 1JIS1'J'{'d/iz c' Aural .Su1:~•('i)'. By JA~IES P. C.A:-JSEI.LS, 2\f,]),, c;Jns-
1
gnw.---])eflning aural surgery a-; surgical cmnmon sctbc rightly ap-
plied, 1>r. C;:i.s.-iells insi:..;tecl that, ina~much as all intelligent surgery was
co11.;;.;crratiYc in its ain1s, anral surgery was so likewise, because aurn.l
surgery was simply general surgery, plus special l<nowledge. J;ut this
claim cl iel not rest on inference alone ; for it was capetblc of proof that
aural surgery possessed this principle, anel that it did not exist as a
scicntilic pursuit if it lacked it. \Vhilc he admitted that the principle
die\ not always arrest the passing attention in general surgery, it was
otherwise in the surgical treatment of the diseases of the organs of
special sense, because normal function in them depenclerl upon the com·
plctc integrity of their tissues. Apart from this, howe\er, there \Yere
special reasons why aural surgery was prc-c1ninently conscrYatiYc; these
\\·ere : r. Diseases of the car did not tencl of themseh·es to natural
cure, but to liecome progressiYely worse, and more serious in their con-
SC<jucnces ; 2. Of these diseases, only those were preventable and
curable that admitted of surgical treatment. These conclusions were
the outcome of his own experience and ohserYation. Regarding the
congestive di~c:-ise:-; of the ear as those in which surgical treahnent was
clcrnanded, he consiclercll them the only ones in which the conserYalive
principle \\·as applicable, an cl thal early incision of congestell tissue
m1s the foundation of conscrYalive aural surgery. Accepting exanth-
cmal catarrh of the tympanum and its appendages as typical of these
congesli1·e affections of the organ, he sketcher] its natural history, and
pointed out the two stages in its progress in which aural surgery, as a
Jll-cvcnliYe anel preservative mclhorl of treettment, \\·as specially incli-
rnlcel ; urging its adoption upon the attention of those present, on the
grounds that this disease, in its initial stage, was capable of being
arrested, and that, in its laier stages, its rarnges were ]imitable hy the
proccecling \\·hich he rccommcnde,\ to their notice. \Yhile he directed
attention specially to this disease as the one in \Yhich aural surgery,
as a conservative measure, \\·as applicable, he desired to say that its
application \\as not confined to it, hut \\·as called for in all the conges-
ti,·e affections of the external car as well, out of which many serious
complications arose. IIc then rcfcrrrecl to paracentesis of the mcm-
lirana tympani as the operation representative of conservative aural
surgery, hccause this principle was first noticed in connection \\"ith the
t reatmcnt of the disease, the history of which he had sketch eel, by the
operation which he hacl just named, and which he now recommcnclcd
to the profc~sion, with ccrtrrin 111odiflcations based upon and ~uggcsted
liy a more perfect pathological an cl clinical knowledge. I Ie then
glancerl at the history of the operation, \Yhich was, inclcecl, the history of
the origin of the principle of conservatism in this department of medi-
cal science; and concluded hy saying that the aims of aural surgery,
,\·hcllicr cxhil)itcd in silnplc incision of congested tissue, or in the more
pretentious operation of paracente.sis of the membrana tympani, \\·ere
to prevent ancl to presen-e, and that it """ misapplied if employee\ for
any other object.-1\Ir. LF'iI> (~Ianchestcr) asked the form ancl direc-
tion of the incision in the memlirana tympani, and the kind of knife
usccl.---:\lr. Rn-1:-;r;To'i (London) said that Dr. Cassells' proposal was
no nm·clty, as it \l·as merely an extension of the plan of cutting through
the mern bran a tympani when fluid was effused into the tympanic cavity.
It restecl with the general practitioner to carry out the suggestion, as
the aural surgeon only saw the case when the mischief was irreparable.
They should, therefore, examine the state of their patients' ears during
the stages of scarlatina. Specialists were now endeavouring to press
their specialism on the general practitioner ; and this would certainly
he a benefit to the public.-1\Tr. LENNO:\ IlRO\YNE (Lonclon) agreed
with l\Ir. Rivington as to his vie1rs on specialists. The latter di<] not
sec cases until the mischief \\·as clone. They \Yerc, therefore, r~rateful
lo Dr. Cassells for directing attention to a means of prc\-cnting those
seqtwlx of which otorrhe£a was the most favourable, and \\·as c\cn cx-
pcctecl. He agreccl with him as to incision \Yhere there was pus ; but
he clouhtecl if the general practitioner would incise Lefore fluid col-
lcclecl. The incision by the knife betel the advantage OYer the perfora-
tion by ulceration of healing rapidly.-Dr. C.\SSE!.LS, in reply, rclateel
the case of the chilcl of a mcelical man brought to him after reaeling
one of his papers. The hearing in one ear 'rns gone ; but, hy this
operation, that of the other \ms saved. I Ic did not lay claim to origin-
ality, as the operation hacl been introelucccl by Saunders, the father of
English aural surgery. He himself hael pointed out the clcfinitc stages
at which the operation should he clone. In scarlatina, the incision
should always he made before the fluid accumulated, so as lo get reso-
lution. \Vhen in general practice, he had always acteel on this rule.
As to the operation, he die\ not, from want of time, gi1·e precise de-
tails. They conic\ he found in the C/11.\''"W "11'·dical _!<>11r11al for 1872.
The incision shoulel he maeie from top to bottom, in the miclclle of the
posterior half of the mernbrana tympani, behind and parallel to the
hanrllc of the malleus, as fluid collecteel behind in the m01stoicl cells.
Pro<·incia! S10,~t'IJ' in .Sf_·l'f!a11d, i!lustra!t'd !ya1st.'S trea!td in ll1t• Alka
ll<>sfita!. By PETER BRoTllEI(STe 1:-;, F. R. C. S. Ed., Alloa.-The hos-
pital hets been in existence for the last six years, and is situated on rising
grouncl, a little to the north of the town of Alloa. The po]'ulation of
the town is about ten thousand, an<l that of the county fourteen thou-
sanel; nnd the building has been found completely adequate to the wetnts
of the locality. The surgical hospital consists of two ware\>, with six
beds each; and a small room for seclusion, with t\Yo beds, an operating
room, kitchen, nurses' apartments, etc. There has been no difficulty
in procuring funcls for its mainlenetnce; and the erection of similar in-
stitutions was urged wherever neeclccl, from consideration of the favour-
able results that have been here obtained. During the six years of its
existence, there haye been lre~ted in it nine fractures of the raclius and
ulna ; four fractures of the neck of the humerus; t\\·o fractures of the
humerus; ten fractures of both hones of the leg, fourteen fractures of
the thigh, and one compound fracture of the thigh, all of \\·hich re-
coverccl. Of ten amputations of the thigh, eight reco\ erecl. Of four
excisions of the !<nee, only one clicl well. Of four amputations of the
leg, two amputations of the arm, three amputations of the fureetrm,
twenty-four amputations below the carpus, four excisions of the mam-
m•-c, one case of lithotomy, one case of extirpation of the testicle, all of
which recovered, as well as the ordinary amount of smaller cases, I
need not specify. The average annual expenditure h'.ts been about
.£250; and the whole original cost of the institution was £r,2jo, in-
cluding furniture, etc. There was built in connection with the surgical
hospital a house for the treatment of infections diseases; and it is, in
all its arrnngemenh, entirely separate. It consists of two wards, con-
taining in all fourteen bed>. This separate building is partly main-
tained by the Burgh arnl Parochial Board, each contributing £ro;
and it has been found of the greatest serYice, on several occasions, when
Alloa was threatened with an invasion of smetll-pox anrl typhus
fever.-Dr. G. H. B. l\lAcLEOIJ (Glasgow) remarkeel on the interest of
the paper as showing the immense benefits of such proYincial hos·
pitals. As the surgeon, ho\\·evcr, of an infirmary once feel from Alloa,
hut now hardly getting a single case from it, he hardly saw tl1c a,\ van-
tages as strongly as Mr. Hrotherslonc clicl.
Aew Operation for l/m111it,d J·iw·t11r«s. By MATTIIE\\' II11.r.,
F.R.C.S., and l\LKC.l'.Ecl., Bootle, Liverpool.-The operation de-
vised by Mr. Hill for the cure of unnnitecl fractures consists, like
Dieffenbach's, in driving iYory pegs into the fragment, but is different
in all other respects. The olcl operation entails a large wounel in the
soft parts and exposure of the lione, in short, renders the fracture
"compound"; in the new operation this is aYoirlell, the pegging being
done subcutaneously. The necessary tools are an Archimcclcan-screw
clrill·stock with two or three drills, and iniry stilettes about four or live
inches long. The drill and stileltes arc similarly graduated in half
inches, and the ivory is, moreover, grooved like a director in order to
facilitate its introduction alongside the drill, and aftenyarcls to allow
the escape of inflammatory fluids, \Yhich might otherwise be pent up in
tl1e bony fragments. Tl--e 11wd11s of(Ttntdi consists in entering the drill
through a puncture maclc by a tcnotomc ; the borin~ of the hone is
next proceeded with, the graduations enabling the operator to calculate
his clepth to a nicely. The ivory stilttlc is now filed transversely half
way through, at a distance from the point corresponding to the cleplh
of the hole in the bone; it is next slid down beside the drill, which is
then withdrawn, the stilette slipped into its place, lightly hammered,
and with a sharp twist broken off at the notch, flush with the surface of
 THE BRITISH MEDICAL JOURNAL.
the bone. The remainder of the ivory is now withdrawn, and the punc-
ture sealed with a strip of plaister. It is obvious that as many pegs
may be introduced in this manner as is thought desirable; in the
au.tho~'s case three '".ere introduced without causing any subsequent
m1scluef or the format10n of abscess. The punctures healed kindly and
by the "first intention''.-Dr. G. H. B. MACLEOD (Glasgow) said
that the operation was undoubtedly something new, and he only re-
gretted they did not know the end of the case. For his own part, he
had seen such admirable results from the antiseptic treatment of open
wounds, that he preferred to cut down on such cases antiseptically.
Mr. Hill's method, however, was most ingenious.-Mr. J. D. MOR·
RISON (E<linburgh) drew attention to his modification of the Archi-
midean screw, by which only one hand was needccl, and greater deli-
cacy of touch secured.-1\Ir. LUND (;\fanchester) had tried the method
of drilling bones, but had become disheartened. Jie used a five-sided
broach. l\fr. Morrison's ingenious instrument would be a great help.-
Mr.ANNANDALE (Edinburgh) had found the common bradawl or pricker
~f the joiner to work as well as any apparatus. It was cheap, in addi-
tl~n, only costing about threepence.-Mr. HILL, in reply, said that the
dnll-stock was a minor point. The important fact in the operation
was its being done subcutaneously.
On Section of the Cornea in certain Dismses of the Eye of Inflam-
matory Origin. By J. VOSE SOLOMON, F.R.C.S.E., Birmingham.-
The l_ale l\lr. Guthrie recommended that large collections of pus in the
antenor chamlier shou!d be treated by a free vertical incision through
the cornea. Mr. Solomon tried this plan in a case in 1852; but the
result was unsatisfactory, probably because the operation was too long
deferred, In 1873 and 1874, he successfully treated by free incision
several cases of extensive hypopyon, abscess, and diffuse purulent infil-
tration of the cornea. The general results of his treatment were, im-
mediate relief from pain; preservation of the curve of the cornea, and
consequently lessened astigmatism; the prevention of synechia anterior
and staphyloma; and limitation of the resulting Jeucoma. The cicatrix
formed merely a thin white line. Several illustrative cases were de-
scribed.
On the Treatment of some Diseases affecting simultaneous!;• the Voice,
Speech, and IImring. By LENNOX BROWNE, F.R.C.S.Ed., London.
Subcutaneous Operation for the Relief of Fibrous Anky!osis of the Knee-
·7oi11t. By C. F. MAUNDER, F.R.C.S.Eng., London.-The patient
was a man, aged 33, who was admitted into the London Hospital, on May
12th, 1875. About three years ago, the right patella was broken into
three pieces. The knee had been stiff ever since, and he had injured
it on two other occasions. Amputation had been suggested. He
walked like a man with a wooden leg, swinging the right limb in a
half circle. The joint was the seat of firm fibrous ankylosis; the frag-
ments of the patella, and the tibia and femur, being immovable one
upon the other. On l\fay l9th, the patient being under the influence
of chloroform, Mr. ?.launder forcibly flexed the leg, the adhesions
breaking audibly. There was considerable swelling and ecchymosis
afterwards; bnt no good resulted. On June 2nd, the fragments of the
patella and their fibrous bond of union were severed from the fibrous
tissue occupying the joint. A strong. tenotomy-knife was entered on
the inner side just above the patella; and, the desired section being
made, the wound was closed in the usual way, as in tenotomy ; and
then the leg was forcibly and freely flexed. On the fourth day, passive
movement was commenced, and the patient was encouraged to prnctise
flexion and extension of the leg. On July 27th, he was able to
perform both these movements, and walked with a scarcely perceptible
halt.
On Jo:gyptian Ojhtha!mia and Catamd Complimtio11s: with Cases.
Tiy J. H.. \YoLFE, M. D., Glasgow.-For the last six year,;, Dr.
·wolfe had adopted a new method of treating that intractable disease.
The results were highly sati-;factory, anrl he related the following
cases: I. Granulatiou with pannus of four years' standing; complete
cure; central opacity of cornea remedic'I by formation of new pupil:
2. Granulation with double cataract, of nine years' duration; cured,
and double extraction successfully performed: 3. Granular lids with
pannus, complicated with traumatic cata1 act; pannus cured, and cata-
ract successfully extracted. The method of treatment which he adopted
consisted of: I. Scarification of the whole conjunctiva! c11l-de-sac once
or twice a week; 2. Daily application of the syrnp of tannin (two
drachms to one ounce).
Friday, August 6th.
Professor PIRRIE, and afterwards l\Ir. ANNANDALE, occupied the
Chair.
Remar/.os Oil the Varieties of TVr;•-neck, and its Treatment. By W. J.
LITTLE, M.D.-The author described three groups of cases met with
in practice: I. Those caused by rheumatic and strumous disease of
[August 28, 1875.
the bones, li"aments, and glands of th'! cervical region, and by cica-
trices of bu~ns and wounds ; 2. Those having a congenital origin,
which exhibit more or less ri"id contraction and structural shortening
of one portion or the whole ';f the sterno-cleido-mastoid muscle, and
which present considerable analogy with congenital club-foot! 3.
Spasmodic wry-neck, induced in middle life from derangement ot the
cerebro-spinal nerve-centres. The treitment of cases due to past or
present vertebral disease, and of burn and ciccttrix cases, dem.tnds more
or less elaborate mechanical aid; whilst those arising from congenital
contraction often require subcutaneous division of one or both port10ns of
the sterno-cleido-mastoid, and the subsequent use of a common roller an<!
plaister bandage with a leather-padded collar only, made higher on
the contracted side. Photographs iltustr.lting each of tl1ese lorni,; of
wry-neck before and after treatment "·ere exliibited.-:\Ir. Fou:.ER
(Hanley) asked how the incision was made.-Dr. Lnyu: rcpliccl that
he divided the tendon about one inch aboYe the clav1ck, where there
was the deepest arch below it. Care should be _tak.en thctt the .assistant
did not pull too hard.-1\fr. GRAHA:\I asked 1f, 111 spasmodic casee,
there was any return after operation. In one case he had operated
on, there was no return twelve months afterwards.-Dr. LITTLE had
had a case of recurrence two months after operation. In these cases,
according to Langenbeck "ml Stromeyer, the knife actecl as a narcotic.
He did not mean to question the accuracy of l\1r. Graham's observa-
tion, but yet congenital wry-neck often appeared like the spasmodic
form. In the unmistakably spasmodic cases, division did little good.
-Dr. PIRRIE (Aberdeen) had listened with great pleasure to Dr.
Little's paper.
Notes on the lll<'d<rl1 Jiethods of Extracti11s Catar.rct. By C. B.
TAYLOR, M.D., Nottingham.-Since patients suffering from cataract
were operated upon by extraction, no method, when s~1ccessful, had
yielded more brilliant resu! ts than Da viel's process of removmg the lens by
making a flap of one-half of the cornea. The fatality, howeve_r, attending
this operation, even in the most competent hands, had led to its abandon-
ment, and the substitution of various alternative measures. One of the
first of these was advocated by Mooren, who proposed to avoid pro-
lapse of the iris by excising a portion of this membrane soi_ne weeks
prior to the removal of the Jens. This rendered the extract10n muc_h
safer, but it involved two operations, and the risks attendant upon the
large flap remained ; hence Schufte began to extra~t through a small
linear incision, lifting out the lens with a spoon ; this was abandoned
for the more scientific methods introduced by Von Grafe and the author
simultaneously [See original paper by the author in Ophthalmic Review,
1865.) These methods reduced the immediate loss from upwards of ten
per cent. to about three per cent., and diminished the partial failures
one-half. The pupil, however, was sacrificed, and in order to combine
the advantages of a perfect pupil with the safeguard .of an iridectomy,
the author excised only a small portion of the periphery of the ms,
leaving the pupil untouched. This operation yielded excellent results
in the author's hands in upwards of thirty cases, and had been highly
commended from results in his own practice by Mr. Brudenell Carter.
The process, however, was delicate and tedious. To avoid the flap,
retain the advantages of a linear incision, and still save the pupil, lJr.
Kuchler of Darmstadt extracted through a wound made directly across
the centre of the cornea. Mr. Bader of Guy's Hospital also practised
a similar incision, only a little below the pupil ; and Mr. Liebriech
made one a little lower still. Dr. Vincente Chiralt, Lebrun, and War-
lomont had adopted, in succession, exactly the same form of incision
as Mr. Liebreich, but placed it above the pupil. The author had
nevertheless obtained excellent results in some cases with both the
lower and upper forms of incision ; and his experience had been, that
the nearer the wound approached the corneo-sclerotic junction, the less
risk there was of any of the evil results enumerated above. After many
trials, and a careful stll<ly of numerous cases, both in this country and
on the continent, he concluded that the saf.!st form of incision was a
transverse one at about the upper third of the cornea. At first, a por-
tion of iris was excised as a part of the operation; but, subsequently,
the author proposed to dispense with the iridectomy in certain cases ;
and afterwards, in consequence of the greater facility and consequent
diminished risk attending the vari0us steps of the operation, a section at
the lower third of the cornea was adopted. In this way a shallow slit-
like flap was formed, comprising only one-third of the cornea, and
lying in the corneo-sclerotic junction. This permitted the ready exit of
the lens through the natural pupil, and left no trace afterwards ; being
close to vascular tissue, it healed rapidly ; any prolapse of the iris was
readily replaced at the time, and if the pupil were maintained in a con-
tracted state by the instillation of Calabar bean, the prolapse did not
return. The wound healed in twenty-four hours, after which atropine
might be used if desirable. The operation was singularly safe, and
successful as to the appearance of the patient and the power of vision.
 August 28, 1875 .) THE BRJTISH MEDICAL 'JOURNAL.
Tiu Treatmmt of .Spina Bijida. Dy J. MORTON, l\I.D., Glasgow.
-Dr. Morton's paper on spina bifida referred to the hopelessness with
which such cases were regar,led previously to 1871, and stated that
mauy still regarde<l them as necessarily fatal. In the autumn of that
year, a case presentc<l itself in the wards of the Glasgow Royal In·
firmary, which inducecl him to consider whether he could not abandon
the do-nothing system, arnl it was treated successfully by injecting the
iodo-glycerinc solution. Since that time, six other cases had been so
treated with a like result by Dr. Morton and others. All the lumbar
and dorsal cases treated by Dr. Morton himself had been fortunate.
In only three other cases had the iodo-glycerine injection been used,
and these succt1mbecl, not from any direct effects of the operation; one
\\'as otherwise hopelessly deformed and paralytic, and probably not a
lit case: for any interference; another died from debility ; the third,
under Dr. Morton's own care, died from convulsions due to the drain-
ing away of the ccrebro-spinal fluid, which might readily have been
prevented had the child been resident in the hospital. So far as was
known, these were all the cases in which this mode of treatment had
been employed. Collodion, either commrm or flexible, was used to
close the apertures necessarily made, and had always answered the
purpose. Hitherto seventy per cent. of the cases had been cured, taking
even the worst view of the c~ses ; but, discounting the paralysed and
deformed ones, there might J,e about eighty per cent. The mode of
managing them was describecl.--1\lr. MEADE {Bradford) asked if the
early cases hacl been kept in view, so as t:> see that there was no para·
lysis or other afti:r-effccts.-Dr. MORTON said that he had clone so,
and found no bad effects following. It was curious, that in none of the
cases given was there any paralysis.-l\fr. GRAHAM said that the
i::eneral experience was, that one out of three cases operated on died.
The results under Dr. Morton's treatment were most gratifying, and he
hoped that the good effects would continue.-l\Ir. ANNANDALE (Edin-
burgh) congratulated Dr. Morton on his success. From a large expe-
rience of his own and others' cases, especially those of the late Pro-
fessor Syme, he had come to the conclusion that interference generally
caused death. Indee<l, latterly, i\Ir. Syme did not operate. In some
cases, he had seen spontaneous cures ; but the success of Dr. Morton's
plan was most gratifying.- Dr. l'IRRIE {Aberdeen) felt indebted to
Dr. Morton for his valuable paper. He had listened to it with great
interest. Hitherto his opinions had been similar to those of Mr.
Annamlale. !Jr. Morton's plan, however, opened up quite a new field.
Tn regard to pathological specimens of spina bifida, he might mention
that, in the Association Museum, a very fine specimen of its occurrence
in the lumlx1r region was shown by him. In it a vesicular process of
the sacral nerves coul<l be seen passing through the fissure, to become
aclhereut to the posterior wall.
.-1 Case of Strumous or Tubercular Disease of the Breast simulating
Scirrhus. By R. H. MEADE, F. R.C.S. Eng., Bradford.
1'ttrther Obsei vatious on tht• Electrolytic Dispersion of Tumours. By
TULIUS ALTHAUS, l\f.D., London.--He stated that it was now
·pretty well ascertained what electrolysis could do, and what it could
not do; and that its sphere of usefulness was not likely to be much
curtailed or enlarged by future researches. Regarding the mode of
application, he remarked that the voltaic current was conveyed to the
tumours by means of gold needles, which acted either in fixed rows or
singly, in any direction that might be required, by means of the
serres-fines conductor; and that either the influence of the negative
pole alone, or that of both poles simultaneously, was utilised. Elec-
trolysis was very useful in certain forms of mevus ; and the author
pointed out its advantages over excision, the injection of perchloride of
iron, nitric acid, the subcutaneous ligature, and the galvanic cautery.
Cystic bronchocele yielded readily to it, and solid bronchocele more
slowly. A remarkable case of the latter affection was related, in which
the patient's life was in imminent danger from pressure of a rapidly
growing tumour on the pneumogastric nerve. Sir William Fergusson
had refused to operate, but the patient got ultimately quite well under the
author's care. Sebaceous tumours yielded readily to electrolysis, which
was likewise useful in recurrent fibroid and secondary cancer. It was
not possible by this means to eradicate the cancerous diathesis, or to
prevent the tendency to death; but it was most effectual for the relief
of the pain ; promoted sleep and appetite, and soothed and strengthened
the system generally. Dr. Althaus related a case of secondary cancer
of the breast, in which the suffering had been intense; but where the
last few weeks of life were rendered perfectly comfortable by the use of
electrolysis, the patient ultimately sinking from congestion of the lungs,
brought on by exposure. The author wound up by requesting his
hearers to use electrolysis more largely in suitable cases than had hitherto
been clone, and showed the instruments which he generally employed for
his operations. - Dr. JOHN DUNCAN {Edinburgh) said that Dr.
Althaus had the largest experience of anyone as to this mode of treat-
ment, which, he believed, would come still more into use. He himself
had considerable experience of its use in the treatment of aneurism and
nrevus. In certain cases of aneurism, it was admirable. In aortic
aneurism, however, it was disappointing, as, although it gave relief,
yet it did not cure. It was certainly best in cirsoid aneurism, or
aneurism by anastomosis. He had referred to the treatment of mevus
by this plan ; but for the plethora of papers in this Section, he would
have made a written communication on this subject. The method
was perfectly safe and certain. It had the disadvantages of leaving a
scar when performed too quickly, and of being tedious when done too
slowly. Its use should be limited to cases where it was important to
have no scar, such as the face and other exposed parts. Where a scar
did not matter, something more rapid should be used. In the treat-
ment of other tumours by it, he h-ad little experience. He found it
extremely tedious when done slowly; and, when done quickly, there
was risk of sloughing. This was nothing mysterious. When done
slowly, there was destruction of texture and then absorption. Bui,
when it was too quickly performed, the destroyed texture came away m;
sloughs. He had used with advantage a needle in which the part in
contact with the skin was insulated, and only that below the skin free
from such a protection. In this way, there was no risk of slough or
scar. He could confirm what Dr. Althaus had said as to its giving
relief from pain in certain cases, especially in vascular cancer. In a
case of pulsating sarcoma of the neck.{primary), which he had seen
through the kindness of Dr. George Balfour, there was great pain ; so
that the patient could not sleep for more than ten minutes. After the
operation, however, he got rest for four nights. This fact he could not
explain ; but, from his experience of this and another case, he thought
that the irritation of the electrolysis increased growth ; and, therefore,
the surgeon had to choose between causing increased rapidity of growth
and giving relief to the patient.-Dr. J. C. HnIE could confirm what
Dr. Duncan had said as to the use of an insulated needle. His expe·
rience was limited to two or three cases of nrevus in the face. In the
first, the nrevus occupied the extremity and length of the nose. Un-
fortunately, the child died from bronchitis. In the second case, the
nrevus extended over the whole of one cheek. Although the treatment
was protracted, yet the cure was satisfactory. At present, he had
another case under treatment, where the bridge of the nose, one cheek,
and both eyelids were affected. In none of these cases was there any
scar left.-Mr. LENNOX BROWNE (London) was so well acquainted
with Dr. Althaus's treatment, that he could bear te,;timony to its
effects on r.revi and the softer forms of enlargement of the thyroid body.
Its advantages in treating the latter form of disease, viz., preventing
hremorrhage and lea.ving no scar, he had omitted to mention, when
speaking on this subject at a former meeting of the Section.-Dr.
BUCHANAN {Glasgow) did not feel qualified to give a general opinion
as to this method. But, in regard to nrevi, he believed that, in the
vast majority of cases, excision was the safest, easiest, and best plan.
There were few instances in which it was not applicable.-Dr.
ALTHAUS said that reply was hardly necessary, as most of the speakers
had agreed with him. He was especially pleased with Dr. Duncan's
remarks. In regard to electrolysis causing increased rapidity of
growth, they should remember that Dr. Duncan's case was a primary
cancer ; whereas it was in secondary cancer that it was most applicable.
Tertia1y Sore-Throat. By C. R. DRYSDALE, M.D., London.-Ter-
tiary sore-throat was readily divisible into two forms: r, the ulcerative ;
2, the gummy. The ulcerative form of tertiary sore-throat was seen
chiefly on the tonsils, or posterior wall of the pharynx, aud was com·
paratively rare. It might occasion discomfort in swallowing, and pain
in the ear. It might be extensive enough to remove the whole of one
tonsil. The gummy tumour of the soft and hard palate was the com-
monest, perhaps, of all the symptoms of tertiary syphilis. Gummy
tumour of the velum commenced by the deposition of small masses of
gummy material in the substance of the soft palate, which at an early
stage made the soft palate feel to the touch as if it contained small
bodies, such as cherry-stones or split-peas, in its substance. In a short
time, the inflammatory stage supervened, and the mucous membrane
over the infiltrated part became dusky-red, glistening, or varnished in
appearance. To the touch, the parts felt greatly thickened, and were
sometimes twice or thrice as thick as in the normal condition. The
velum became immovable at the infiltrated part. The disease was
often insidious in its approaches. Patients not unfrequently came to
the practitioner with perforation of the soft palate, who had never
known the clanger they were incurring by their neglect of the very
slight symptoms in the throat. When inflammation had once set in,
the disease went on with great rapidity. The infiltrated part became
softened, and a slough came rapidly away, so that perforation or com-
plete division of the soft palate into two lateral flaps might occur in two
or three days. It was, on this account, of the greatest importance that
 THE BRITISH MEDICAL JOURNAL. [August 28, 1875.

practitioners shouhl be habituated to diagnose at once the characters of needle passed or pressure applied by means of the finger. He thought
the tertiary sore-throat ; since any delay in remedies exposed the patient that the risk of hremorrhage after the /ffaswr or galvano-cautery was
to two grave infirmities. The first of these was the loss of voice, which magnified. Ile had not used the latter in remornl of the tongue ;
was in proportion to the extent of perforation of the velum; and the but had found it of great advantage in removing, \Yithout risk of
second was the regun6tation of food, and especially drinks, by the hremorrhage, syphilitic growths of the genital organs.-Dr. GRAIIA)!
nostrils, when the perforation of the velum was not very small. The had used the galvano-cautery in extirpation of the tongue without
loss of the voice was somc~imes almost total. The regurgitation of hxmorrhage or any untoward result. Bis plan was to sever the lateral
liquids was often a serious matter, producing emaciation and death from attachment of the tongue to the mucous membrane by means of scisrnrs.
asthenia. Perforations of the hart! palate from gummy deposit were A straight incision was then made from the chin to the hyoid bone.
also common, anti produced the same effects ; and were amenable to Two needles were next applied, so as to graze the top of the hyoid ;
the same remedy. In the treatment, caustics should not be used in the and then, by means of a platinum loop, the whole organ could be easily
inflammations connected with gummy sore-throat. Nor should such removecl.-J\Ir. ANNANDALE (Edinburgh) understood Dr. Hirschfeld
tumours be touched with the knife. \Vhat was indicated was the ad- to say that the epithelial form of cancer, which chiefly affected the
ministration of the iotli<le of potassium at once, in large doses of fifteen tongue, had little tendency to spread. He did not think that this was
grains four times daily. Mercury in such cases was powerless, or the case. IIe had operated in many instances, anti found that the
nearly so; and was only to be tried when the iodide failed, which it tendency to spread was very great. It most frequently began in the
did in rare cases. lateral half of the organ, and then implicated the muscles and mucous
The Sm,~ical Treat111mt of Lymphatic Tumours of the l\';>ck. By S. membrane. It was, therefore, advantageous to operate completely.
MESSE!';<;ER HRAllLEY, F.R.C.S., Manchester.-Mr. Bradley limited This could best be done by dividing the jaw. When the disease was
his paper to the consideration of certain nuchal lymphatic tumours, limited, the galvano-cautery could be use<l; but there was risk of a
which he divided into three classes: I. True hypertrophies, with or with- portion of the disease being left behind. Although the galvano-cautery
out a 'lrumous <liathesis, and sl~owing no tendency to break down or ensured less risk of hxmorrhage and left a safer wound, yet he pre-
undergo pathological change; 2. Strumous hypertrophies, consisting of ferred first dividing the jaw, so as to expose the tongue in all its con-
cellular hyperplasia plus caseoois deposit, which, after a time, soften nections. The galvano-cautcry or /trascur could then be usctl.-Dr.
either in patches or entirely, until the gland becomes a mass of soft IIIRSCHFELIJ, in reply, said that he believed the preliminary ligature of
;trumous matter ; and 3. Hard non-infectious lymphomata. l\Ir. the linguals to be a great help in preventing all hxmorrhage.
Tiradley said that, as a rule, these cases were lumped together and The 1Vourish111ent of the /lead c'.f the Femur aflt!r fntracaps11lar Fra(-
treated generally, indiscriminately and unsatisfactorily by the local ture. By F. OGSTON, jun., l\I.D., Aberdecn.-After an introductory
application of imline and the internal administration of cod-liver oil, description of the state of parts in' an old ununited intracapsular frac-
etc. It was his wish to substitute an arm of precision for this hit or ture, and a short review of the theories which hat! been brought for-
miss method; and, from an extensive trial, he was able to say that, by a ward to account for the healthy stale in which the head of the femur is
proper selection of cases, this could be clone. For several months he frequently found after this injury, a thin! method was indicated as an
had injected the harder lymphatic tumours with a few drops of tincture efficient one; viz., that the head of the femur is supplied with an abun-
of iodine, with the almost invariable result of causing a rapid diminu- dant supply of blood by the capsule reflected along the neck. This
tion, going on to complete absorption of the gland. 1-Ie had even suc- view was supported by quotations, by diagrams, anti by reference lo
ceeded in producing absorption of some encapsuled tumours situated on injections of this structure, showing that blood-vessels pass through the
the salivary glands by this means, but confined himself at present to reflected capsule anti pierce the head of the femur, and that this con-
recommending this mode of treatment in hypertrophies of the lymphatic necting band remains uninterrupted in those cases where the head of
glands. As a rule, two or three injections of from five to fifteen minims the J.ione is found well nourished, while it is wholly ruptured when the
of the simple ( l'. H.) tincture of iodine, was sufficient to effect a cure. No head of the bone is found to be wasted. The statement of Hyrtl, that
other treatment was necessary. This plan had the ad vantage of being vessels do .not reach the head of the femur by the round ligament, was
comparatively painless, safe, and speedy. It was not applicable lo all shown to be incorrect, since in one of the cases quoted the injection
lymphatic tumours, and, if used indiscriminately, wouhl fall into dis- entered it by this channel.
favour and disuctude. To avoid this, he laid down the following rules On Fibr~us Tumours of the Auricle. By J. J. KIRK DuNCANSo:-1,
for the surgical treatment of these nuchal tumours : I. Cases to be M.D., Edinburgh.-The auricle is subject to a variety of diseases, and
treated by ln;i:ction of fodin,·: a. True hypertrophies of cervical glands growths of various kinds are found affecting different parts of it, arising
without scrofula; b. Strumous hypertrophies of cervical glands before from the different structures of which it is composed. They may he
they have broken down; c. Hard (non-infectious) lymphomata ; d. All tumours containing hydatids, masses ol f:ttty matter; or they may be
encapsulated tumours, as a tentative operation. 2. Cases to be treated steatomatous, sebaceous, encysted or fibrous tumours. Hypertrophy of
by incision: Lymphatic tumours that have, either with or without the lobule, as well as tubercles of a gouty nature, spread over the auricle,
previous injection of io<line, broken down into pus. 3. Cases of Cer- may occur in subjects of a gouty diathesis. Elephantiasis has been
vical li1mours to b,· lr<'ali'd bJ' Extirpation with the Aiu/~: a. Strumous known to attack the auricle, and cancer of an epithelial nature affects
glands which form tumours riddled with soft patches, and rest- the auricle independently of any other seat in the body. Fibrous
ing on a base of suppurating cellular tissue, with a large area of blue tumours of the auricle occur in the lobule of the ear. They have been
skin ; b. Encapsuled tumours which have resisted the treatment by most frequently met with in the ears of the negroes of the Brazils, and
injection. some African tribes ; hut they are lo be met with in all countries where
Se;·,·rc Ci•rebro-Sfinal .\j•mptoms produced by a Fall at Football. By the practice of piercing the lobule of the car for the wearing of ear-
P. J\I. llR.UJJ\\·uol>, J\l.D., Birkenhead.-The symptoms were pro- rings or other ornaments is customary. Various reasons are given for
Lluced by fall on his back suffered by a young lad through missing a their occurrence by different authors. According lo some, they arise
drop-kick al foutb:tll. He thought the case worthy of the attention of from the act of piercing the lobule of the car in certain constitutions;
surgeons, as being a rare instance of severe nervous symptoms being others say they are caused by the irritation of the articles worn, such as
caused by a slight accident. brass earrings. Shortly after the lobules of the ears have been pierced,
On Extirjation of tilt! lc>ll,i;llt'. By JoHN c. HIRSCHFELD, M.B., or not until some irritation by the articles worn, pain and swelling su-
Banff.-The author briefly commented on the variou< operations for the pervene. These are followed by a more defined swelling in the track
removal of the tongue, and recommcncled the following plan, as ob- of the puncture, and this swelling may become a well marked fibrous
viating the risk of lrn::morrhage, and removing various objections to tumour. l'agd says there may be, perhaps, some doubt whether the
other proceedings. The patient having been·put under the influence of growth be a proper tumour, or a cheloid growth of the cicatrix tissue,
an an<csthetic, the lingual arteries are tied. The vessel is exposed by formed in the track of the wound; but it has the aspect of a tlistinct
making an incision an inch and a half or t\\'O inches in length above fibrous tumour, and the skin appear.> unaffected ; they are recurrent.
and parallel to the great cornu of the hyoid bone, turning up the sub- According lo Billroth, these tumours consist chiefly of spindle-shaped
maxillary gland, and dividing the fibres of the hyoglossus muscle. The cells and connective tissue, and arc merely an hypertrophy of the
mouth is then opened hy <lcpressing the lower jaw; and the tongue is cicatrix, similar to tumours growing from cicatrices on other parts
then cut off close lo the hyuid bone. If the mouth be small, the aper- of the body ,(keloiLI). St. John Roosa ccills them fibro-cartilaginous,
ture may be enlarge,[ by culling from the angle of the mouth into the a11Ll says they are a simple hypertrophy of the normal structures.
cheek. Tlie author believed that epithelial cancer of the tongue had They uccur mure fre11ucntly in the African than in the Caucasian race.
comparatively little tendency lo spread.-Dr. JonN DUl'\CAN (Edin- Anccsthetic .. Jgmts.-On the proposal of Mr. ANNANIJALE, the Sec-
burgh) s:iid that the principle of preliminary ligature of both lingual tion passed a resolution recommending the appointment of a Committee
arteries was a sound one. But it must be remembered that, in almost any to inquire into ar.cl report on the use of anresthetics. (See JOL'RNAL,
operations near the lingual, it could be easily exposed, and an aneurism- August 14th, page 214, col. 2.)
 August 28, 1875.J 7 HE BRJTISH MEDJCAL JOURNAL.
SECTIO:-; D.-l'VBLIC l\!EDICINE.
THE papers in this Section haYe been arranged in the follm1·ing groups,
of which one was taken up on each day that the Section met.
A. Contagion arnl Infectious Diseases.
B. Medical Legislation, J\leteorology and Disease, Statistics of Dis·
case, etc.
C. General Sanitary Arrangements; Drainage, \Yater-supply, Ven-
tilation.
1Vcdncsday, A u_i;ust 4th.
GROUP A.-CONTAC!OUS AND Ii-; FECT!\'E DISEASES.
The President, the Right Hon. Lni:-; l'LAYFAIR, 1\1.P., took the
Chair at 2 P.M.
Contrihution to th,: J:ije-hist"1')' of C,'llta.~ium. By P. l\I. BRAID-
WOOD, J\I.D., and F. \'AcHER, Esq., Birkenhead.-Ilaving carefully re-
viewed the literature of the subject up to elate, including the papers in
the recently issued reports of the medical officer of the PriYy Council,
the authors proceeded to give particulars of their own investigations.
The questions, it was the purpose of these researches to elucidate, were
thus stated: (a) \Vhat is contagium? (b) In what manner is it gene-
rated or communicaterl? (c) \Yhat are the conditions on which its life
or activity depend? The results of inoculations on eighteen subjects
with water containing the soluble constituents of vaccine lymph were
recorded. lt wrrs cxplainecl that diffusion was effectccl in the manner
adopted by Dr. Burdon Sanderson, but the diffusates were more con-
centratecl than those used by previous im·estigators; and the authors
submitted that, hy testing the effects of the cliffusate first, and in no
case vaccinating till a given time rrfter making the abortive insertions,
they avoided a possible source of error with which the method of proce-
dure of l\f. Chauvcau and Dr. Sanderson \Yas chargeable. Of seYenty-
two punctures inoculated with the diffusate, se\'enty-onc failed entirely.
As proving that the exception to 1\1. Chauveau and Dr. Sanderson's
experiments was rnlid, the authors tried the effects of Yaccinating with
lymph pure and diluted simultaneously, ancl fournl that the maturing of
vesicles at the points treated with pure lymph tended to prevent the for-
mation of vesicles at the points treated with the artificially weakened
virus. The conclusion arrived at on this point was, that there is the
strongest indirect proof (there can be no direct proof till we can wash off all
trace of plasma from the bodies it suspends) that the contagium of the virus
with which we are most familiar, consists of particles neither soluble
in water nor in watery lic1uicl. The next series of experiments reported
were for the purpose of determining some of the cornlitions affecting
the activity of the typc--contrrgium. They consisted of animal vacci-
nations, rctrovaccinations of CO\\'S and heifers, inoculations \\·ith lymph
preserYed by different methods for various lengths of time, and vacci-
nations with mixtures of lymph and various so-called antiseptics or
germicides. As regards the results obtained from this last group of
experimenh, it was stated that combinations of vaccine and carbolic
acid solution for sixty-four insertions yielded nine vesicles; that sul-
phurous acid vaccine failed to produce vesicles ; that ozonisecl and
chlorinised vaccine also entirely failed ; tlrnt vaccine mixed \Yith a
saturated neutral solution of quinine )etaincd its activity; that a mix-
ture of lymph and liquor potassx pennanganatis (ll. l'.) gave doubtful
results; that chloralum on being mixed with lymph did not affect its
activity. The thin! series of observations referred to tire local mani-
festations incidental to vaccination. The authors vaccinated a heifer
at several points, and day by clay removed 'mcccssiYc portions of skin
where vaccine had been inserted. Sections, vertical arnl oblique,
were then made and tinged "·ith carmine, these being subjected to
examinations with high and low powers. The preparations and draw-
ings from them \\·ere exhibited.
On th.· ,\;11111«· of Co11ta,i;io11. By T. J. MACLAcA:-;, 1\1. !>.,Dundee.-
The author first referrer! to wlrnt is known regarding contagion, and then
proceeclcd to show that the view which gave the best explanation of
co.existent facts is that \Yhich regards it as consisting of minute living
organism>, probably of albuminous composition, po'5cssing the pc\l·cr
of organic clevelopmcnt ; always reproducing their own kine! ; capable,
under favourahle circumstances, of preserving their vitality for rr con-
siderable period ; but speedily perishing when separated from these con-
clitions arnl freely exposed to the atmosphere.-Thc PRESIDENT said
that long ago he was a strong rrdvocate of the chemical theory of con-
tagion; arnl the most heautiful specimen of inductive reasoning we pos
sessed \ms Baron Lichig's chapter on contagion and miasm. Modern
research, ho\Yevcr, 1"Hl given little support to this view. The Ycry
specific c11aractcr of contagion-its power of reproduction----,Ya~ an
argument in favour of the germ-theory. It \ms as certain that
whatever produced scarlet fever would produce scarlet fever, as
that a dog would produce a puppy, or a rose-tree would produce
a rose-tree.-Dr. CARPENTER (Croydon) pointed out that, in
the dilution of the vaccine lymph with distilled water, the
small quantity of alkali in that water might hC>ve rendered the
vaccine material inactive, C>llll hence followed the want of results which
might lrrrvc follower! \Yitlr the addition of some chemical agent such as
carbolic rrcid. As to contagion, he thought it was to he traced to
some organic germ, which might, under certain meteorological or physi-
cal conditions, clevelope into one or other of the diseases to which the
human body was liable.-1\Ir. J. A. \YANKl.YN (London) pointed out
that, 'though the water used to dilute the lymph referred to in the first
paper was not perfectly pure, the experiments were all the more cogent,
inasmuch as they proved that contagia were clcstructible by water.
This fact of the germ-forms losing their power was of Yery great im-
portance; rrnd, if they admitted the accuracy of these experiments,
they must admit the possibility of destroying every poison-germ hy
dilution. As to the nature of contagion, while not defending the
chemical theory, he held that, unless they could cliscriminrrte germs, the
germ-theory lrarl no Yitality in it.-Dr. l\IACNA)IARA (Calcutta) was
doubtful as to diseases being alone capable of reproducing themselves;
for scarlet fever was never found in India, or cholera in Australia,
although both countries were in communication with the \Vest and with
each other.
Scar!d Rn·r: l low to Pre,,ent its Spread. Hy J. l\I. Fox, J\I. R. C. S.E.,
Annaside, Cockcrmouth.--The paper commenced with a statement that
facts in sanitrrry science are sometimes brought to light with grerrter
distinctness in small towns, where observation may be more complete
and conditions arc less mixed, than in larger urhan arcrrs. An epi-
demic of scarlet fever during I 87 4 in Cockermouth had impressed the
writer with the conviction that, in order to prevent the spread of this
complaint, it is essential that local sanitary authorities should, under
the aclvice of their medical officer, have the full statutory power: r.
To fine the parents or guardians of children attending any school from
an infected house; 2. To close all schools, public and private, during
such time as their order may direct; 3. To order the disinfecting rrnd
lime-\rnshing of such premises. Ile also considered that all dame·
schools an<l other schools, public and private, shoulcl, in regard to all
matters affecting health, stand to the local authority precisely rrs
lodging-houses and slaughter· houses do ; rrnd that it should not be
lawful for any school, public or private, after the passing of a statute to
that effect, to be opened without a certificate signed by the Chairman
of the Local Authority, defining the number of children to be accom-
modatecl in such school, and otherwise approving its general sanitary
arrangements. The paper strongly urged the Association lo use its in-
fluence, in order to obtain these additions to sanitary law. These re-
commernlations were illustrated by reference to the epidemic of scarlet
fever in Cockermonth alluded to aboYe. The town !rad rr good sani-
tary character, heing well situated and having a goocl system of sewer-
age and a faultless water-supply. There were but two deaths in the
year from typhoid fever, one from typhus, and nine from diarrhcea, fiye
of which occnrrccl in the workhouse. There were t11·0 deaths of adults
from diphtheria, one in a house saturated with scarlet fever poison,
and the other that of a hutcher Jiying nerrr a slaughter-house now
closed. All the other slaughter-houses were well kept, being under
frequent inspection. Not a single fatal case of scarlet fever, and very
few of illness, \\'ere found amongst adults ; indeed, out of thirty.four
deaths, only four occurred under one year of age, the remaining-thirty
being between the ages of two and scyen and a half years. It seemed
clear, therefore, that the disease did not follow the track of any known
sanitary defects, and that children, not young infants, were the sole
objects of its attack. It \ms admitted that the health of children is a
test of general hygienic conditions; but not to that degree that any
such conditions are known \rhich mark out children exclusively as their
viGtims. Public conveyances and pawn-shops 11·ere kept under rigorous
ovdsight, arnl were m no case believed to have been the means of
propagating tire disease. The difficulty of sending young children to
a hospital for infectious complaints was felt. The fact that this cannot
be done in many cases 11-ithout sending the mothers also, proves that
this is not quite the kind of separation to he sought in dealing with
this complaint. Rcgrrrding this difficulty, and the age of the sufferer
from scarlet fever, \\'hat is rather wanted is the prevention of the
assemblage of children in all schools, especially public schools and
dame-schools. Jn the new code of regubtions puhlishccl by the Eclu-
cation Department in 1874, there is a clause, page 6, specifying that,
"if a school lrrrve closed during the year under medical authority, on
account of a local cpiclcrnic, a proportionate reduction is rnacle from
the number of meetings and attendances rC'Jllire<l", ror the purpose of
a money capitation grant. If this provision cxi,t, "hy not the power
authoritatively to make use of it? and if there is tire poll'er to close
public schools, why not private infant schools also, whose sanitary con-
dition is usually much worse?
 THE BRITISH MEDICAL JOURNAL.
Is Enteric Fever ever spontaneously Generated? By CORNELIUS B. Fox,
l\I.D., Chelmsford.-The author remarked that the question of paia-
mount interest and importance to all engaged in the practice of the highest
branch of the profession, namely, preventive medicine, has been one
which seems to have divided the most distinguishecl physicians into two
parties, one section giving an affirmative, and the other a negative
answer. Sir \Villiam Jenner, in an excellent address delivered before
the Clinical Society on January 12th, 1875, pointed out, whilst dis-
cussing the etiology of the fever, that the best mode of settling this
much debated query would be to study every isolated case occurring in
out-of-the-way country places. Dr. Fox, as medical officer of health
over the central, eastern, and southern portions of Essex, had, with
this object in view, investigated thoroughly during the past two years
every isolated case in his district, many parts of which are only con-
nected with the outer world by the most primitive methods of com-
munication. He recorded a summary of 27 isolatf!d cases in this ex-
tensive area, which he has, in a sceptical frame of mind and animated
with the sole desire of ascertaining the truth, carefully subjected to an
exhaustive scrutiny. Of these 27 cases of enteric fever, three were
~]early traceable to pre-existing ones. He divided the remaining 24
rnto two classes-the "doubtful'', and the "decidedly nntraceable"-
and placed 16 under the former, and 8 under the latter heading. The
"doubtful" class comprised those respecting which there was a shadow
of a doubt. Details were given of two of the most interesting of the
eight "decidedly untraceable" cases, namely, the outbreaks of Asheld-
ham and Langford. In the first, the apparent cause was excremental
pollution of water, and in the other an excremental pollution of air.
The Langford outbreak was one of the most striking cases that had yet
been made public, showing the strongest probability of the development
of the fever from fa~cal fermentation, all other possibilities of origin
having been eliminated. The arguments which had been employed by
both the parties of the controversy were examined and discussed, the
reply of those believing in the spontaneous origin of the fever to the
principal argument of their opponents being considered unsatisfactory.
The researches of Chauveau, Burdon Sanderson, Beale, Klein, Bastian,
and I-Iallier, the theory of the omnipresence of typhoid germs, the
views as to the dissemination of the disease by other articles of food
besides milk, and the suspicion of a connection with the consumption
of meat from fevered or diseased animals, were only briefly alluded to ;
th~ object ?f the :iuthor being to limit himself strictly to the point
raised by lus questwn as presented to the public health physician in his
work in rural districts. The experience of Dr. Fox tended to show-I.
That enteric fever is sometimes spontaneously developed ; 2. That it
spr~ad~ ~y contagion in t'.'e overcrowded. dirty dwellings of the poor,
'".lulst it is rarely communicated from the sick to the healthy in capacious,
mry houses where cleanliness in all things is the rule ; and 3. That the
immunity in the latter case is ascribable to the prevention of air, water,
and food pollution by the poison, and to the dilution of the poison, and
perhaps its destruction by the natural or artificial disinfectants, if the
air be impregnated therewith.
7}'ph_oid rt"l'l'r in the Isleo.f Sl:l'e. By }As. BROWN, L.R.C.P., Vig.-
The object of the paper was, without entering into any description of
the symptoms or treatment of typhoid fever in Skye, to expose at least
two evils, which were asserted to be the causes of the frequent out-
breaks there. After showing that the outbreaks could not be attributed
to bad water, since the water in Skye was excellent, the author asserted
the two chief causes to be : I. The almost universal habit amono- the
crofters of lodging their cattle under the same roof as themselve,;'; 2.
:rhe scantiness of sleeping accommodation, large families being crowded
mto two, and sometimes one, apartment. Besides these evils, there
was the practice of keeping piles of manure in front of the cottage-
doors, and having peat-fires in the centre of the room, with no means
of egress for the smoke sm·e the door and window, and a small hole in
the roof. The difficulty of remedy was the tenacity of the islanders to
okl custom,. The remedy suggeste<l was to remove the cattle, and
lodge them outside, by which an additional apartment would be at once
available for the accommodation of the family. In most of the cases
of typhoid fever, a tendency lo relapse was observed, which was
att1 ibuted to the constant prc,ence of the exciting cause -impure atmo-
sphere. The lungs were frequently attacked in these cases of relapse,
and great discomfort was, of course, occasioned by the foul atmo-
sphere. Again, owing to scantiness of accommodation (in evidence of
which the remarks of Lord Young in the late Snizort case at Inverness
were adduced), isolation was impossible; and the fever could not be
confined to only one or two members of the family. The paper con-
clu~l~d by declaring. the readiness of the proprietors to afford every
facility for the erectwn of separated wellings for the cattle. The remedy
would be inexpensive, owing to the abundance of stone, the only con-
siderable expense being the roofing of the houses.
[August 28, 1875.
On a Village Outbreak of Enteric Fcver traceable to a Sp,xijically Pol·
lute.i /Vater-mppf;•. By D.wm PAGE, l\I.D., Kendal.--In Decem-
ber and January 1874-5, a sudden outbreak of cnteric fever took place
in Stavcley, a village of \Vestmorland, midway betwixt Kendal and
\Vindermere. Twenty.five attacks and four deaths, the cases being
well marked, and, with three exceptions, of a severe type, were re-
corded in connection with the outbreak, which, in its chief extent, fell
with remarkable incidence upon those houses dependent for their water-
supply upon a rivulet flowing through a portion of the village. Although
subject to almost constant pollution from drains and gutters at various
points above the houses referred to, the water of this brook had been
used with impunity for years. At the beginning of November, an
elderly man came from Kirkoswald, in Cumberland, where enteric fever
had recently prevailed, ill of the fever, and was laid up in one of a row
of seven cottages situated hard by the edge of the brook, some 800
yards higher up its course. He died on January 9th, and, during his
illness, there was positive evidence of the discharges having been
thrown into the stream. Between November 28th, the date of the next
case, and January 21st, out of forty-two families who. either habitually
or at times drank the water, thirteen, or nearly one-third, were attacked
with typhoid fever. Two incidents of peculiar value, from the clue
they afforded to the determination of the incubation-period of typhoid
fever when spread by means of a specifically contaminated water, hap-
pened in the progress of the outbreak. On November 14th, a girl,
whose parents resided in one of the houses by the edge of the stream,
came home on a short visit from a farm-house in the valley of Longs-
leddale, seven miles away. She returned to the farm-house on
the evening of the following day, and, on December 2ncl, was seized
with typhoid fever exactly eighteen days afterwards. Her brother at
home in Staveley was similarly seized on December 9th. Both were
severe attacks. In the other instance, a pump, which had hitherto
been kept in working order, in spite of the intense frost of December,
was frozen hard on the night of the 29th. The nearest pump was
160 yards distant, and several families resorted to the stream. Out of
seven who used the water, four were attacked on January Ioth, one on
the 11th, and one on the 12th. The pump was thawed on January 1st,
so that the use of the water was limited to a couple of clays ; besides
which, in each instance, it was averred that the supply had been taken
on one day only from the stream. Calculated from the earlier date or
the later, the period of incubation in these six cases would be from
ten to fourteen days. The cessation of the outbreak wa> coincident
with the alarm created by these nearly simultaneous attacks, which led
to the abandonment of the stream for the time, the last case referrable
to the use of water from that source occurring on January 21st. In
three families only of the thirteen did multiple cases occur; viz., in
two, two cases respectively, and three cases in the third. Of the
eighteen cases directly traceable to the water-supply, three only were
adult males, the rest being women and children. As the male popula-
tion were chiefly employed in the bobbin-mills in the neighbourhood,
their immunity might be in part explicable by their greater absence from
home. Regarding the remaining seven cases of the twenty-five, three
were solitary cases. One was that of a woman who had occasionally
waited upon one of the other sufferers ; the other two lived outside the
village, under circumstances which excluded any connection with local
sanitary defects; but both had been in the habit of frequenting the vil-
lage, and might in that way have contracted the infection, although it
was impossible to trace its origin in this direction. The other four
cases occurred in the farm-house in Longsleddalc, to which the fever
had been brought by the girl whose case was mentioned. The cases
were severe; two children and two adults were attacked, two of the
cases enclin" fatally. There were no local circumstances which coul<l
in the remotest manner account for the spread of the fever, inasmuch
as the water was derived from a spring issuing from the rocky hill-side
ahove the house, and there was strong evidence lo show that the manner
of infection was by the actual swallowing of solid particles of excreta.
In conclusion, the author cited several examples of the occurrence of
typhoid fever under conditions wl:ich il_lustrated the di!ficulties in !he
way of making sure that the negative evidence upon which the quest10n
of the spontaneous origin of the fever necessarily depended was cnm-
plete evidence, and without prejudice to either side offered a contribu-
tion of facts to the etiology of the disease. I. \Yater polluted with
excremental matters had been used with immunity for years. 2. This
water, on the addition of the dejections of a typhoid patient, became
the carrier of the contaaion. 3. The incubation-period is not neces-
sarily shortened, but may even be of prolonged durat~on, equally in the
spread of typhoid fever by the agency of water as of a~r.-?r. ~RITTON
(Halifax), from numerous cases that had occurred m his neighbour-
hood had come to be of ooinion that enteric fever might arise spon-
tane~usly.-Dr. CARPENTER (Croydon) said they wanted more facts
· August 28, 1875.] THE BRITISH MEDICAL JOURlvAL.
before they could determine as to the spontaneous or non-spontaneous
origin of typhoid fever. Some time ago, he had a large number of
cases, the sources of which he was unable to find, and he then came to
the conclusion that they had arisen sud sponte, although that scarcely
represented the state of his mind at the present time. The germs of
disease might have lain dormant for many years in the situations where
they were placed. He remembered a practitioner in Ohan informing
him of some such cases occurring in Mull. A proprietor of that island
ordered the removal of some old houses which had lain in a state of
ruin and uninhabited for many years. Eight men were employed in
digging the walls, and every one was attacked with small-pox, the
germs of that disease having lain in these houses all those years. Now,
if the germs of small-pox had lain dormant for many years, why not
those of typhoid fever? As to the incubation of typhoid, he knew
that in the Croydon outbreak it varied from five days to over two
months. That outbreak in Croydon, during which there were 500
cases, he had traced to the effects of an intermittent supply of water
coming after a constant supply. A hydrostatic vacuum was thus
caused, and all the noxious gases from the surrounding soil were ab-
sorbed by infiltration.-Dr. Ross (London) ascribed much of the typhoid
in large towns to emanations from cow-houses, cesspools, and walls
soaked in sewage which had escaped from broken drains or overflow-
pipes.-Dr. MARSHALL (Greenock) said that one cause of enteric fever
had, he thought, been overlooked. In certain states of health, the
enteric system of the patient itself created poisons which might poison
the patient. Gases or germs might be germinated in the body in cer-
tain states of health from the low state of digestion, and a sudden ex-
posure to cold might set this poison-manufactory agoing.-Mr.
STEPHEN ALFORD (London) said that, in the high parts of London,
typhoid fever was constantly sent up the drains from the low districts,
the flow of water downwards driving the noxious gases upwards. The
question of trapping drains thoroughly was a much more important
one than the spontaneity or non-spontaneity of enteric fever.-Dr. A.
P. STEWART (London) said that it was a curious fact that many of
the most destructive epidemics of typhoid that had occurred had not
arisen in crowded cities, but in rural districts, where there was pme air
and seemingly plenty of pure water. He narrated the case of a friend
of his, who went to inspect a boarding-school previously to sending his
two daughters thither. Everything he liked well, but the drain, which
passed within three feet and a half of the well. When he spoke of
this, he was informed that the water of the well had been drunk for
years, and that no disease had ever occurred. To satisfy himself, he
twice had samples of the water taken and analysed, and it was found
lo be perfectly pure. He sent his daughters to the school; but, in two
or three 'Yeeks, typhoid fever broke out, and of four deaths which oc-
curred one was that of his youngest daughter. The water of the well
was then found to be putrid from the sewage which had found its way
into it.-1\Ir. BARTLETT (London) mentioned that he had analysed the
water in his house nine times before he found a trace of contamina-
tion; and this contamination had been caused by what Dr. Carpenter
had pointed out : the hydrostatic vacuum, resulting from an intermittent
supply, drawing in noxious gases.-The PRESIDENT, in bringing the
discussion to a close, referred to the interesting and important nature of
the subject. However different opinions might be held as to the
spontaneous origin of enteric fever, there was one thing they could
all practically do, whether as medical officers of health or in private
practice ; viz., war against filth in all its forms. By taking as a text, in
their broadest sense, the words of the prophet, " \Vash and be clean",
they could do a great deal to prevent the spread of enteric fever and
all other kinds of infectious diseases.
An Outbreak of Enteric Fever in the Village of Killamarsh, Derby-
shire. By A. MACKI:-ITOSH, M.D., Chesterfield. - Dr. Mackintosh
sketched the geographical and geological features, and the sanitary con-
ditions of the locality, and then gave a history of the outbreak. He
believed it to have arisen de novo through drenching sewage-water and
inhaling sewage-emanations. He could not observe evidence of con-
tagion in any case. · Recently he had charge, along with Dr. Peddie, of the representation
On the l'ropagatio11 of Typhus Abdo111i11alis. By EDWARD \V.\TERS,
l\f. D., Chester.
On the Ages at Deat!tfro111 Small-pox, kleasles, and Scarlatina. By J.
\V. TRIPI,, M.D., London.-The calculations were made from 2,516,468
deaths from all causes in England during the fiye years 1868-72, and
embraced 48,435 deaths from small-pox, 47,341 deaths from measles,
and I 12,412 deaths from scarlatina. The deaths were given for every
year of life under 5; then for 5-15 years, 15-25, 25-45, 45-65, and 65
and aboYe. Dr. Tripe showed that, out of each 1,000 deaths from
these diseases, 149 occurred from small-pox, 200 from measles, 65
from scarlet fever, during the first year of life; that, in the second year
of life, the mortality from small-pox decreased to 53, whilst that from
measles increased to 376, and from scarlet fever to 147, in each l,000
deaths from these diseases. Up to five years of age, the mortality
from small-pox remaiced about the same in each year of life, whilst
that from measles much increased, and that from scarlet fever in-
creased in the third year to 165 per l,000, and then decreased to 120
in the fifth year. The proportions of deaths from these diseases during
the first five years of life were as follows: from small-pox, 350; from
measles, 920; and from scarlet fever, 646; whilst from all causes the rate
was 407 in each 1,000 deaths. Above five years, there were, therefore,
650 deaths from small-pox, only 80 from measles, and 454 from scarlet
fever, per l,OOO at all ages. This remarkable difference was attri-
butable, in Dr. Tripe's opinion, to vaccination affording but an imper·
feet protection against an attack at later periods of life, as compared
with an attack of the d;sease itself. Dr. Tripe thought, however, that
even if an individual should not have had any of these diseases, he be-
came less susceptible to infection as age increased; and that this dimi·
nished susceptibility occurred very early in life as regards measles,
later on (above 15) as regards scarlet fever, whilst it did not take place
for small-pox until about 40 years of age. The extraordinarily small
proportion of deaths above 5 years from measles, above I 5 from scarla-
tina, and above 45 from small-pox, formed the data on which this
opinion was founded.
On some Points connected with Cottage Hospitals. By JAMES Coo!'ER,
F. R. C. S. Eel., Cromer.-The following questions were discussed in
this paper. Are cottage hoo,pitals likely to injure the old established
hospitals ? To what extent should they be self-supporting? In what
way should they be provided with medical attendance? Should medi-
cal men give their services gratuitously?
ThursdaJ'• Attgust 5th.
GROUP B. MEDICAL LEGISLATION: METEOROLOGY AND DISEASE I
STATISTICS, ETC.
/'resident's Addrtss.-The President, the Right I-Ion. LYON PLAY·
FAIR, M.P., delivered an address, which was published at page 173 of
the JOURNAL for August 7th.
On the necessity of Legislation for the Contr<'l and 7i·eat111mt oj
Insane Drinkers. By A. PEDDIE, M.D., Edinburgh. [Seep. 253.]
On the Contt·ol awl Restraint of .Habitual Drzmkanls. By G. F.
BoDINGTON, M.D., Kingswinford. [Seep. 255.]
Sir ROBERT CHRISTISON, after thanking Dr. Peddie and Dr. Bod-
ington for their papers, said he desired to submit a resolution. A
well considered resolution on this subject, brought forward under the
auspices of the Association, ought to have great weight. Therefore
they should be careful what they said, but at the same time very re·
solved to carry it out. He moved :
"That excessive intemperance is in many cases a symptom of a
special form of insanity, which requires special treatment, with a view,
first, to the recovery of those affected, and, second, to the protection
and advantage of them and of society. That in the present state of
the law such treatment is not attainable, and that it is desirable that
legal provision sl:ould be made to render it attainable."
The subject, he said, was one which occupied his attention at a
very early stage of his professional career, in consequence of his oc·
cupying the Chair of Medical Jurisprudence for ten years. At that
time he lived with his brother, who was a member of the Scotch bar.
At their common table, he used to meet several of the most eminent
members of the Scotch bar, and there was not one of these gentlemen
who did not scout the idea of putting habitual drunkards under re-
straint. \Yhat they mged was, that they could not distinguish be·
tween a habitual drunkard who was suffering from disease and one
who was suffering from the effects of vice. But in course of time several
of these gentlemen came to see instances of habitual drunkenness in
relatives and friends. Gradually conviction stole upon them; and he
believed that now, among Scotch lawyers generally, there was a feel-
ing that some sort of restraint should be placed on habitual drunkards.
which was being got up by Mrs. Dalrymple for presentation to the
Home Secretary, and in the comse of a day and a-half he got that docu-
ment signed by the professors of Metaphysics, of Moral Philosophy, of
Political Economy, and, what he considered of more consequence than
all these, the professor of Scotch Law-[hear, hear, and applaus~]-ancl
not only by him, but by a former Solicitor-General for Scotland, now
Dean of the Faculty of Advocates. [Applause.] A great deal had been
said in print and in the papers as to the difficulty of distinguishing be-
tween habitual drunkenness the result of vice, and habitual drunkt:nness
the result of disease. He suspected they must acknowledge that this
unfortunate condition was not very often purely the result of disease.
He had seen it so, but by far the greater number of cases arose in
. 268 THE BRIT/SR MEDICAL JOURJVAL.
consequence of the persons having gradually yielded to the vice. They
must consequently face this fact-not try to evade it-and show the
Government and the Legislature that the cnses in the end were not
different-that there was no difference in their features and in the re-
sults to the drunkards themselYes, to their families, and to society at
large. "When, in the little society to which he had alluded, he was asked,
" How are you to distinguish between moderate excess and such ex-
cess as you consider bordering on insanity?" his reply was, that he was
always very cautions about giving definitions. He was once asked in
the witness-box to gi,-e a definition of insanity or unsoundness of mind.
He knew very well that this "·as but the introduction to a dexterous
cross-examination, and he replied that that was a problem on which
twelve judges in England had exercis~cl their ingenuity and hml failed;
that many men had written on the subject and failed ; that, there-
fore, it was not to be expected that he should succeed ; but that, if
counsel would bring a case before him, he should not only satisfy
himself, but satisfy his questioner, whether it was a case of insanity.
[Laughter and applause.] His reply to the doubters on the question
under cliscnssion was the same: Bring before me a case, and I will tell
you whether it is to be acconnted for by disease or not. He was rather
inclined to borrow a name from the pure English, and call this drink-
craving; that was the real essence of the thing-the man had such a
craving for drink th:it he could not resi;;t it. It would, he dared
say, be often difficult to distinguish, but they could always decide on
examination. [I£i·11r, hc,rr.] Then, if they did make a blunder, and
introduce among clrink-cravers a man who was not so bad, was any
harm clone to him? Ko, but a great advantage, for they took him in
time; no harm was done to his friends, whom he was ruining, and no
harm to the public : in fact, it was one of the extraordinary cases
where an error could do no harm. [Ilcar, hMr, and laughter.] He
hoped the Association would adopt the resolution, and go forward to
the Legislature. They had a righteous cause ; and, in his long expe-
rience, there ne,·er had been any right thing, notwithstanding all diffi-
culties at first, that was not eventually carried in the House of Com-
mons if they could get some zealous member to bring it forward. [Ap-
tfa!ls,'.]
Mr. Ilt'sBAXD (York) seconded the resolution. As medical men,
they did not require to be satisfied that there were such persons as
habitual r!nmkarcls, but the public mind and the Legislature required
to be educated on the point. There was no one who had had large
opportunities of practice but must have felt this to be one of the greatest
clifliculties of his professional life, and more especially when women
were the subjects of the vice. He never knt:w an intelligent medi-
cal man who had any doubt as to the propriety of placing such people
under restraint. He hoped that on !iOme member of the House of
Commons the mantle of C\fr. Dalrymple would fall, and that a proper
measure would ere long p:iss. [Applause.] The Council of the Asso-
ciation were, he said, taking steps in the matter, and at next annual
meeting it was hoped they wo11lcl present a full report. [Applause.]
Dr. MORRIS (Baltimore), as a trustee of an institution for receiving
inebriates in America, said Americans were not a people who would
b"ar restraint very well, ancl it might be supposed that they would be
the last in the world to submit to a Jaw of this kind. But in several
States there were such laws for the restraint of drunkards--laws appa-
rently stringent, but not actually so in operation. "'hen any man or
head of a family was known as a habitual drunkard, and any two re-
spect:ible householders went before a judge and declared that, the man
was committed to the inebriate asylum, as it was called, and kept there
for a certain term-generally a year. The very fact of the existence
of the law was a deterrent to drinkers. IIe would say, Do uot let
this bugbear of restraint of personal liberty have any weight with you,
for \Ye Americans, who know what liberty is, or at least think we do,
do not find that it interferes with us. [Applause.] The institution to
which he referred look in three kinds of inmates : first, those who paid
nothing; second, those who paid a moderate sum, such as working
classes could afford, from r8s. to 25s. a week ; then the educated and
wealthier classe:<, \rho paid a fair price. The original institution was
too near the city, and patients frequently strolled thither and got spirits.
Now they had bought a farm five miles from tmrn, and they intended
to build a new institution on the cottage system, and to classify the
inmates. The institution \rnrkcd admirably ; it was not self-support-
ing-, but they got a small contribution from the State and subscriptions
from the public. They con!tl nol make an absolute cure under t\\·o
years, for it required that time before the molec11lar structure of the
brai:i tissue>, destroyed by habitual drinking, was entirely reconstructed.
They had thirty-three per cent. of cures, and when a reconstructed and
rebuilt clerk or merchant left the institution and went about amongst
his friends, the merchants put their hands in their pockets and paid
for that reconstruction by subscriptions.
[August 28, 1875 .
Dr.JOSEPH ROGERS (London) said it continually happened that per-
sons were sent to the poorhouses in England, Ireland, and Scotland,
who were suffering simply from the effects of drink. After a few days
they recovered, and as soon as they were able to crawl over the door
they demanded and got their liberty. He thought power should be
given to enable the authorities to detain such habitual inebriates. IIe
thought that there were too many brewers and publicans in the House
of Commons. [Applause.] That was the true explanation why no
proper redress could be got from the present Parliament;..
Dr. J. C. REID (Newbiggin) said that one of the evils of the Scotch
Lunacy Act of 1843 was to do away with the power which the Scotch
had possessed from time immemorial of sending their drunkards to
one of the islands in Loch Lomond. [Heat, hear.] All the talk as to
the restraint of drunkards interfering with the liberty of the subject
was balderclash. The liberty of the subject was interfered with from
the date of his birth. [Laughter.] One could not be born but an Act
of Parliament stepped in and said he must be registered ; then he must
be vaccinated by order of Parliament ; and when he grew older, and
wanted to take a sleeping partner into the concern, he could not be
married in England after twelve o'clock. [Laughter.] \Vhat was
worse still, he could not be decently laid away in his coffin without
an Act of Parliament interfering with the liberty of the subject. But
the law was too lenient, ancl would not interfere with the liberty of the
subject who was an enemy to himself, to his family, and the public weal.
[f:f,'t11·, hear.] He hoped the time was not far distant when the law in
regard to chemists and doctors would be made to apply to publicans.
If a chemist sold poisorr and a person died, he was held responsible ;
and if a surgeon made a mistake, he was held liable in an action for
malpractice. Why should the publican be freed from the same liabi-
lity? Make the publicans responsible, and there would be far fewer
unhappy homes. [Applause.]
Mr. LIDDLE (London) believed the love of strong drink was engen-
dered very much among certain classes by the miserable condition of
their dwellings and by overcrowding.
Dr. A. P. STEWART (London) said great harm was done by the
statements made in regard to the identity of habitual clrnnkenness and
disease. If they went before Parliament on the ground that it was a
disease, they took up perilous ground indeed. If they said a man was
a maniac, they would be told to send him to a lunatic asylum; and if
they di<! that, more harm would be clone than good. He approved of
Sir Robert Christison's proposal to invent a new name. For nearly
three hundred years the power, originally given by James I, had existed
of interfering with the liberty of the subject because he was drunk ;
that was, the magistrate imprisoned a man for a clay or two for being
drunk. Let the principle be extended to continued restraint, and they
\vould touch the evil.
Dr. C.\llPENTER (Croydon), in reference lo the committee appointed
by the Council of the Association to report on the subject, said that
Committee would be glad to get all the information possible, and he
hoped members would send in all they could.
The PRESIDENT said he lrnd acted on the Committee upon Habitual
Drunkards with his friend l\Ir. Dalrymple. He entered tlw Committee
in an extremely duubtful state of mind, his feeling being hostile to the
proposal ; '1.ncl this he had told l\fr. Dalrymple. He then thought they
must look chiefly to education and diffusion of knowledge among the
people as the means of preventing drunkenness, and that restraint was
a Ycry questionable mode of procedure. But he confessed that
the evidence brought forward led him to a different conclusion
before the labours of the Committee were closed, and he signed the
report a<lvocating certain forms of restraint as being necessary in the
case of habitual drunkards. It was because the public were not suffi-
ciently educated on this nrntter, and because they had not shown suffi-
cient interest in it, that the House of Commons was unable at present
to legislate. The Association would do great good by the resolution it
might adopt, but that was not sufficient. The members must educate
the public, and the House of Commons must feel that it would be sup-
ported by the public in legis!:lting on the subject. The present mind
of the House of Commons was, that there were great difficulties con-
nected with the subject, and that they must look these difficulties in the
face. Jlut he was afraicl the House was like the Highland clergyman
of whom Dr. Norman Macleod used to tell, who said that, whenever
he saw a difficulty, he looked it fully in the face, and then passed by
on the other side. [Lau,;.,'lt,r.] If, ho,vever, the public took up the
question for themselves, the llouse of Commons, finding public feeling
supporting them, would soon pass a measure. [Applause.]
The resolution was then carried by acclamation.
State llklici11i: i1t Re!aiiou Iv Education. By HENRY J. VELD, M.D.,
Sunderland.-In his introductory remarks, Dr. Veld pointed out that
the legislation of recent years has placed the children of the working
 ·August 28, 1875.) THE BRITISH MEDICAL JOURNAL.
classes in a much better position, as to the sanitary and other conditions
under which their education is carried out, than those of the middle
classes, and affirmed that, in the matter of education, there has been
class legislation, and not legislation for the general welfare of the com-
munity. The object of this paper was to bring prominently before the
public the unsanitary and other conditions under which many thousands
of the children of the middle classes and upper section of the lower
classes are educated. For this purpose, he first stated what may be
considered as the necessary requirements for healthy and efficient educa-
tion : l. The school buildings should be perfect in their sanitary arrange-
ments, and in every other respect; 2. Education should be physical as
well as moral and mental ; 3. To meet this requirement, a playground
should he attached to every school ; 4. Persons engaged in tuition
should possess a certificate of their competency to act as teachers, and
should have some knowledge of the l::iws of health. After a few remarks
upon each of these points, he proceeded to show to what extent the
schools now existing throughout the country, for the education of the
children of the middle classes, fail to meet these requirements, taking
the hundred private schools in the borough of Sunderland by way
of illustration. On inspection, only twelve of the humlrcd "·ere
schools specially built for the purpose of education, the remainder being
rooms in dwelling-houses used as school-rooms; thirty schools were
overcrowded and defective in their sanitary arrangements; while, with
regard to their ventilation, in 90 per cent. the only means of ventilation
was by the windows, and in most instances hy a single window, there
being no special means provided whereby the air might be kept pure.
To several schools there was no water-closet or other accommodation
at.tached! and only .fi"e schools had playgrounds adjoining. Lastly,
with a Y1ew of placm~ these schools on a more satisfactory basis, an<l
more in accordance with the spirit of the age, he proposed that an act
of Parliament he pa>sed or order in Council (if sufficient) be issued,
providing: I. For the registration of all persons acting as teachers
throughout the country ; and that, from and after a fixed date, no per-
son be registered without producing a certificate of competency from an
educational examining board. 2. For the registration of all schools,
not directly or indirectly under the control of the Privy Council, at the
office of the local authority. 3. That, at the time of such registration,
a certificate shall be produced, signed by the surveyor and medical
officer of health of the local authority, stating that the premises pro-
posed to be registered are in every way adapted for the purpose of
education. 4. That the number of children allowed to be educated in
such school shall be fixed by the local authority. 5. That the medical
officer of health, or other officer of the local authority, shall have power
to inspect such schools, from time to time, at any hour between 9 A.~!. and
5 P.~r. 6. That with a Yiew of encouraging the erection of efficient
schools, the Privy Council shall have power to make grants of money
towards the erection of such schools on such conditions as may be
determined upon.
The Anomalies and Dtjicimcies ef Parochial lliedical Relief in Scot-
land. By JOSEPH ROGERS, 1\1.D., London.-Dr. Rogers began by re-
marking that, in 1869, a Select Committee of the House of Commons
was appointed for the purpose of inquiring into the working of the
Scotch Poor-laws. This Committee, of which Mr. Crawford was chair-
man, collected during that year and the following a yoluminous mass
of evidence. In the year 1871 they agreed upon their report, and in
the following year l\Ir. Crawford brought in a bill, which was based
upon the Committee's report, but was, however, lost upon the second
reading. Since the rejection of the Bill, no steps had been taken to
remedy the evils that were shown to exist ; and, as an amendment of
the system of medical relief was em braced in that Bill, it occurred to
him that he might revi,·e the subject. After giving a sketch of the sys-
tems of Poor-law medical relief in England and Ireland, he pointed
out that in 1873 the gross poor relief in Ireland amounted to £927, 730,
or 3s. 5~4 d. per heacl of population, although thot sum included an
outlay of £155,362 spent on medical relief; this latter amount consti-
tut~ng t.he sixth part of the total outlay, for a population of 5,344, 151;
wlulst 111 the sa.ne year there was expended on the poor in Scotland
£873,075 for a population of 3,360,068, or 5s. 27-(d. per head of popu-
lation, of which sum only £34,000 was expended on medical relief, or
in round numbers about the twenty-sixth part, against the sixth part ex-
pended in Ireland. Of this sum of £155,362 spent on medical relief
in Ireland, £z4,279 went for medicines and medical appliances: if a
proportionate sum were expended in Scotland, the outlay for medicines
alone would cost the parochial medical officers £15,264. To make the
matter more clear, he contrasted certain Irish with certain Scotch towns.
Belfast has a population of 202,641 ; the medical relief in 1873 cost
£4,078; gross relief amounted to £30,042. Edinburgh, with St. Cuth-
bert's combination, has a population of 209,917; it spent in medical
relief in the same year £1,558 5s. 2d., or not half that of Belfast, while
the poor relief expenditure was £52,455, or £z2,ooo more. He also
gave the following tables as showing contrasts.
Medical Relief. Gross Relief.
Population.
£, s. d. £ s. d.
Glasgow ............ 170,553
2,377 0 0 40,875 0 0
Haror.y 234, rr5 2,057 0 0 43,623 13 2
Dundee ............ 86,527
564 12 I I q,971 8 3
... \tri:•JJ' ............ 72,079 2,100 0 0 8,267 0 0
Armagh ............ 72,384 l,638 0 0 6,489 0 0
Greenock 721 19 4
59,795 9,698 0 0
Lo11doml1'YJJ' ...... 58,758 l,910 0 0 4,747 0 0
Aberdeen ......... 47,077 246 6 10 12,512 16 0
fl111t,t;t11/llOJI ......
45,990 l,069 0 0 4,587 0 0
The author next inquired whether any proof could he adducecl show-
ing the benefits arising from finding the medicines and paying a reason-
ably fair stipend for services. Bonhill, Dumbarton, has a population
of 9,408; the medical officer gets a stipend of £78: 19: 7; all medi-
cines arc found. The poor relief amounts to £1,597. In the adjacent
pari'h of Cardross the population is 7,080; £46 : 8: 2 only is paid for
medical relief, out of which medicines haYe to be found; the poor-rate
amounts to £1,390, or only £zoo less than in Bonhill with 2,328 more
people. In Cardross, last year, the poor relief had risen up to
£1,469, nearly £100 in excess of Bonhill, medical relief remaining as
before. As an instance of great disparity in payments for services,
he quoted Old and New Deer, Aberdeenshire. New Deer had a popu-
lation in 1871 of 4,853, of which number 152 were registered poor and
their depcndents, and 50 were casual poor and their dependents, total
202, wit11 7 lunatics. Medical relief cost £30, me,Jicines being found
by the medical officer; the total gross relief amounted to £803 : 9 : 2.
Of this number of paupers 7 either died or were otherwise got rid of
in the course of the year. Old Deer has a population of 5,085; there
were 257 registered poor and dependents, 94 casual poor and de-
pendents, and 24 lunatics: of this number 30 died or otherwise disap-
peared; the total poor relief was £1,624: 10: 7. Although the popu-
lation, pauperism, gross 1·elief, sickness, and mortality, was so much
greater than in New Deer, the stipend out of which everything had to
be found was only /.,9 : 10: l more than in New Deer. He would ask,
what chance does there exist that the sick poor in Scotland get proper
medicines when they have to be supplied from such stipends? The
system of medical relief in Scotland had a deteriorating moral effect on
all connecred with it. Referring to the enormous extent of some of the
rural districts, he remarked that the whole of Sutherlandshire, with au
area of 1866 square miles, and a population of 26,000, is divided into
five medical districts-Assynt, Eddrachillis, Golspie, Helmsdalc, and
Tongue, including several minor parishes. The district of the medical
officer of Assynt extended 14 miles in one direction, and 28 in the
other. The whole sum paid for medical relief in this county amounts
to £595• out of which horses and drugs have to he found. He could
not give much information as to the interior arrangements of the
various poorhouse hospitals; but if the description given of Barnhill
Poorhouse, Barony-in a very able and evidently truthful report, for-
warded to the House Committee by the medical officer-were typical
of their general condition as receptacles for sick people, it was clear
that there existed as great a necessity for a sweeping alteration in their
arrangements, as he had shown to be necessary_in the treatment of the
out-door sick.
Mr. ERNEST HART (London) moved:
"That in the opinion of this Section the intere:;ts of the sick poor of
Scotland would be furthered and the system of poor-law medical relief
would be placed on a more satisfactory footing, if the following measures
of reform were adopted universally throughout Scotland-viz., that the
cost of medicines be supplied by every Parochial Board, exclusive of
the salary of the medical officer; that medical officers be removable
from office by the Board of Supervision only; that the Parochial Boards
be required to superannuate such medical officers at the proper time;
and that the Parliamentary grant in aid of medical relief be placed on
the same footing as in England and \Vales. That this resolution he
reported by the Chairman of this Section to the general meeting of the
Association; and that the aid of the Association and of the Scottish
Branches in particular be requested in support of an effort to gi\•e legis-
lati \'e effect to the above recommendations."
Nearly all the defects pointed out in the Scotch Poor-law had, he
said, been removed in Ireland and England; and although, on the sur-
face, such a measure appeared to involve greater expenditure, in the
long run it promoted economy in health, life, and money.
Dr. A. P. STE\\".'\RT (London) seconded the resolution, which, after
some remarks from various Scotch Poor-law medical officers condemn-
ing the present system, was adopted unanimously.
 THE BRITISH MEDICAL ')OVRNAL.
On the Steadint'ss of flit' relations betwem 'fVimther and filortality in
Lonc!M. By ARTHUR M!TCIIELL, M.D., F. R. S.E., Edinburgh.-
The object was to show that the distribution of deaths from many of
the particular causes of death over the different weeks of the year, as
deduced from the records of a long series of years, was substantially the
same as that for each <1uinquennial period, or for each single year, com·
posing the long series. This was shown to be true even of epidemic
diseases like small-pox and scarlet-fever. It was further shown that
such divergences as occurred in the distribution of the deaths over the
weeks of the year, between one year and another, or one period of
years and another, answered to corresponding divergencies in weather.
Deaths from diarrhcea, which were greatly under seasonal influence, were
used to illustrate this. The general conclusion was, that the relation of
deaths from many diseases to weather was so steady as to constitute a
feature in their natural history.
The /11j111m<"<: <f IVeathcr on the DMtlt-ratc from dijj;Tmt JJi.«'t1sts
and at dijjerent A,~<'S in I.ondon and in Twemy-fo1tr Lar.re Tmuns
vfGrMt Britain and Ireland. By ALEX. Bucl!AN, A.M., P.R.S.E.,
Edinburgh.-This paper was illustrated by a large series of diagrams
showing by curves the weekly mortality of London from the more pro-
minent diseases, and the weekly mortality of the other large towns from
all causes, from diarrhcea, and of infants under one year of age. The
results for all the large towns show during the winter months an excess
above the average mortality. As regards the English towns, the excess is
greatest at Norwich, \Volverhampton, and Nottingham; and least at
Bradford, Leeds, Salford, and most other towns in the north. In Scot-
land, the winter excess is greatest at Aberdeen, and least at Leith and
Greenock. At Dublin, the largest monthly mortality, 22 per cent.
above the weekly average, occurs during February and March, being
from a month to six weeks later than the time of the maximum of the
English and Scottish towns. In all the English towns, the minimum
mortality of the year is in the spring months, the amounts below the
averages of each town being greatest at Norwich, Wolverhampton,
Birmingham, Leicester, and N"ottingham. In Scotland, on the other
hand, autumn is the healthiest season. In Glasgow and Edinburgh
the deaths fall about 20 per cent. below the average in the month of
September. During the period of high temperature in summer, every
one of the large towns of England sho\\'S an excess of deaths above the
average, with the single exception of Bristol, at which place, while
there occurs an increased mortality at this season, it only comes near
to, but never quite reaches, the average. Taking any two consecutive
weeks which indicate the highest mortality, the excess per cent. above
the average is for \\' olverhampton, 6; Manchester, 8; Portsmouth, 12;
London, 14; Hull, 20; and Leicester, 47. The excess above the
average at Leicester is thus eight times as great as that of \Vol-
verhampton. In Scotland, no town exceeds its average during the
hottest weeks of the year; but, on the contrary, the death-rate every-
where is under the average, and, in most cases, very considerably so.
As regards London, it has been shown by Dr. Arthur Mitchell and
the aut'.ior (:fo11rnal of Scottish fifeteorological Societ;•, vol. iv, pp, 229
and 238), that if the deaths of infants under one year of age be taken
from the total mortality, the summer excess disappears from the curve;
and, it is further shown that, if deaths from cliarrhcca be deducted from
the whole mortality, the summer excess disappears equally as in the
former case. These results hold good for every one of the large towns
for which the required data have been published. Looking, then, at
the large towns of Et1gland, Bristol has the least excess of infant mor-
tality, the highest average of any week being only at the rate of eight
calculated on an annual mortality of l,ooo of the whole population.
In London, the rate rises to ro in the end of July and beginning of
August; and in Liverpool it rises to 16, a rate which is also reached by
the deaths in Leeds, Hull, and Sheffield, and closely approached by a
number of the other English towns. At Leicester, however, it shoots
up to 22 and 24 in the second and third weeks of August. The
season of minimum infant mortality is everywhere during the spring
months in the sixteen large towns of England. The smallest spring
mortality occurs at Portsmouth, the smallest summer mortality at
Bristol ; the largest summer mortality at Leicester, and the largest
mortality during the other nine months of the year, at Liverpool.
From the beginning of November to the summer solstice, the mor-
tality from diarrhcea is everywhere small, being clouble, however, in
Liverpool and Manchester as compared with London and Portsmouth.
The following is a list of all the large towns of Great Britain arranged
in the order of the greater or less prevalence of fatal cases of diar-
rhcea during July, August, and September, the figures being the aver-
age weekly death-rate for the thirteen weeks, calculated on the annual
mortality per l,ooo of the population. /11 Enxtand: L~icester, 9.56;
Salford, 7.15; Leeds, 7.02; Manchester, 7.00; Liverpool, 6.28; Shef·
field, 6.20; Birmingham, 5.78; Hull, 5.56; Nottingham, 5.36;
[August 28, 1875.
Norwich, 5.02; Newcastle, 4.61; Bradford, 4.42; Wolverhampton,
4.03; Sunderland, 3.89; London, 3.45; Portsmouth, 2.94; and Bristol,
2.38; in Scotland: Dundee, 2.14; Glasgow, 1.90; Greenock, 1.75;
Paisley, I. 71; Leith, 1.45; Edinburgh, 1.23; Perth, 1.08; and Aber-
deen, 0.96. The summer temperature of the Scottish large towns is
several degrees lower than that of the English towns, and we see that
every one of the Scottish towns has a mortality from diarrhcea lower
than the lowest mortality of any one of the English towns. The diar-
rhcea ·mortality of each town is found from year to year to rise propor-
tionally with the increase of temperature, but the rate of increase differs
very greatly in different towns. This points to other causes than mere
weather, as determining the absolute mortality ; and it is the investi-
gation of these causes, which may arise from topographical, social, or
sanitary conditions, peculiar to each town, which calls for instant and
most serious attention. In order to work out the problem of the rela-
tion of the weather and mortality of our large towns, it is indispensable
for the comparison of the different towns with each other, that the
system of meteorological observation be uniform at all places, parti-
cularly as regards the hours and modes of observing the temperature,
humidity, and movements of the air, and rainfall; and it is further in-
dispensable that several meteorological stations be established in each
of the large towns.
On Deaths by Accidmt in the Nav;1 and Army. By Inspector-
General \VM. R. E. SMART, C.B., l\f.D., Haslar.-The collation of
statistics through thirteen years showed, that these stand as 3 in the
navy and 1 in the army against .707 in the metropolis per 1,000. The
admission for treatment from all causes amounts to 132. 9 per 1,000 in the
navy against 114.3 in the army; the excess in the former being made up
of hurts, which stand as 29.5 in navy to 9.3 in army per 1,000 men. The
deaths from this cause are nearlv in the same ratio, between ro and 11
per 1,000, in both services, to the admissions "hurt" The inference
was, that slighter injuries are treated among seamen than among
soldiers ; and that the increased ratio to mean strength or per 1,000
force, 3 in the navy to 1 in the army, is made by the greater number
of injuries and not by their greater severity; which is not borne out by
comparative lists of recorded injuries of a directly fatal nature, which
are strongly against the navy. Reasons for this were assigned. The
excess of total mortality in the army per 1,000, 16.6 against I 1.6 in
navy, is made up by the death-rates of diseases, which stand as 15.3
army against 8.4 navy; showing the greater salubrity of ships than
that of barracks and camps. To fill the death-rate by accident of 3 in
the navy against 1 in the army per 1,000 men, there fell in battle .16,
I. 72 died by drowning, and 1.16 by other accidents; and, in the army,
in battle .137, by drowning .426, and by other accidents .435. After
stating that medical hygiene had already affected very much in lower·
ing the dtatlt-rate by tf!smse in both services, Dr. Smart descanted on
the possibility of similar results regarding the deat!t-rate by accidents,
and suggested the good that might be anticipated if combatant officers
of both the public services were instructed in the laws of hygiene in
their colleges and schools.
On the Numerical Ratio ef Disease in the Adult fifale Community
deduced from the Sanitary Statistics of Iler fofajes~v's Customs, I-011do11,
for tlte;•ears 1857-74. By WALTER DICKS0:-1, 1\1.D., R.N., London.
-The registration of disease is an acknowledged desideratum in public
medicine. A more accurate and complete knowledge of the rate of
sickness, and its incidence on various classes of the population, would
throw light on some important social an:l economic questions, one of
the most urgent of which, at present, is the true position of the nu-
merous benefit societies established by the working classes for mutual
aid in sickness, and comprising, according to high authority, four
milions of persons, and holding eleven millions sterling of property.
Very many of these institutions are known to be in a most unsatisfac-
tory [financial condition, in consequence of miscalculation as to the
claims which they may be called on to meet. Mortality rates are ascer-
tained with mathematical precision; hut the ratio of industrial inca-
pacity, by reason of illness, is as yet but imperfectly known in those
classes of the community whom it most interests. The army, navy, police,
prison, and Poor-law records do, or might, yield valuable information ;
but the bodies of men of whom they treat are too fluctuating, and their
circumstances too exceptional, to furnish reliable representative data
for this purpose. In the sanitary statistics of the Customs' officers of
the Port of London will, it is believed, be found a fairly correct est i-
mate of the health-condition of the middle-class, middle-aged male
population. They are, for the most part, resident in London, and oc-
cupied from eight to twelve hours in daily labour, attended, in mo<t
instances, with considerable fatigue and much exposure to the weather.
They form a permanent force, leaving it seldom except on promotion,
death, or invaliding; and resemble in all essentials the majority of
the well-doing industrious section of the community, who have to earn
. August 28, 1875.] THE BRITISH MEDICAL JOURNAL.
their daily bread and maintain families in a position removed alike from
luxury and from indigence. These officers are all under medical surveil·
lance during their service of thirty or forty years; and the records of their
sickness and results have been kept with as much fulness and accuracy
as the nature of the subject will allow. Their age ranges from 21 to
65; the mean age at present is 38. Although embracing a limited
number, the records extend over so long a period that they may be
considered as typical of a large force. The numerical ratios of 28 years
(which is equivalent to that for one year of 32,000 men), are, mean daily
number incapacitated, 27 per l,ooo; admissions to sick-list in year,
700 per l,ooo; mean duration of each case, 15.5 clays; time lost per
man annually, l l clays, exclusive of Sundays, 9. 5 clays ; mortality from
disease, r1.5 per l,060, and from accident, r.3 per l,000; in all, the
deaths are 12.8 per l,ooo; superannuations orinvalidings, 8 per l,ooo;
death and invaliding combined, 21 per l,ooo; recoveries so as to re-
sume duty, 979 per l,ooo. Of the various classes of disease, the ratio
of those of the respiratory organs amounts to 27 per cent. of all the
cases, 20 per cent. of the time lost, l l per cent. of deaths, and l 8 per
cent. of the superannuations ; phthisis yields 1.4 per cent. of cases,
8 per cent. of time lost, 31 per cent. of deaths, and 9 per cent. of super-
annuation; rheumatism and gout show 14 per cent. of sickness, only
0.4 per cent. of death, but 33 per cent. of snperannuation; diseases of
the heart exhibit l per cent. of cases, 2 per cent. of time lost, l 3 per
cent. of the deaths, and I. 5 per cent. of superannuations ; diseases of
the digestive organs give l 7 per cent. of cases, 13 per cent. of time
lost, 9 per cent. of deaths, and 7Y. per cent. of superannuations; dis-
eases of the nervous system amount to 7. 5 per cent. of the cases, 9 per
cent. of time lost, 9 per cent. of deaths, and 20 per cent. of superannu-
ations, ro per cent. being for insanity ; skin and other surgical diseases
give l r. 5 per cent. of cases, roper cent. of time lost, but hardly any
deaths or superannuations. Zymotic diseases occur in the small propor-
tion of 6 per cent. of the whole amount of sickness, and 7 per cent. of
the whole mortality ; and no instance has occurred in many years of
any officer having contracted such illness on board ship, a remarkable
proof of the extreme healthiness of the port of London in regard to
its vast foreign traffic, and of the satisfactory health of the Customs'
force. Phthisis and heart-disease are the most fatal diseases, causing
one half of the whole mortality. The former claims 4 per l,ooo men as
its annual victims, of the mean age of 41 years. Heart-disease destroys
r. 5 per l,ooo, at the average rate of 48 years. Accidental injuries con-
stitute ro per cent. of the cases, l I per cent. of the time lost, and 9.5
per cent. of the mortality. Drowning causes 4. 7 per cent.; fractures,
etc., 3 per cent.; and suicide, r.8 per cent. of the whole number of
deaths. These deaths from violence amount in all to the rate of l per
l,ooo of the force.
On the .iliortality of Adolescence. lly JOHN BEDDOE, M.D., F.R.S.,
Clifton.-This paper was founded on a statistical basis, and chiefly
on the figures published by Mr. Charles Ansell, junior, of the Na-
tional Life Assurance Society. The author showed grounds for be-
lieving that puberty had an influence in increasing mortality, especially
among young females of the upper class, the rates of girls of the lower
class and of boys of both classes being less affected ; and he touched
briefly on some questions of hygiene suggested by these facts.
The Causes of Iuvalidi11,i; amon,1; Convicts in the Governmeut Prisons
of England. By D. NICOLSON, 1\1. B., Portsmouth.
Tobacco, and its Ejjetts on the IIealth of llfales. By CHARLES R.
DRYSDALE, M.D., London.- The author said that the result of a paper
by him read at Norwich had shown that, although very many, far too
many he thought, eminent physicians and surgeons made use of tobacco,
yet none could be found bold enough to say that the practice of smoking,
chewing, or snuffing was consistent with health. The population of
the British isles used some fourteen millions sterling yearly in the pur-
chase of tobacco, pipes, etc. l'\ evertheless, there had always been
able medical objectors to the sainte herbe. The alkaloids contained
in tobacco, or in tobacco-smoke, were very poisonous ; and, when
smoke was taken into the mouth, a portion of such alkaloids dissolved
in the saliva, entered the circulation readily enough. Smoke breathed
in small rooms, or railway carriages, also poisoned to a certain extent
all who inhaled it, whether smoking or not. The first cigar or pipe
showed the effects of amte tobacco poisoning, producing nausea, vomit-
ing, hiccough, <lyspncca, prostration, coldness of the extremities, cold
sweats, and intermittent pulse. Chronic poisoning by tobacco, the
ordinary disease seen in practice, was tested by Blaton, who admi-
nistered two or three grains of tobacco daily to clogs with their food.
The animals lost appetite, had diarrhrea, swelled gums, loosening of
teeth, irregular action of the heart, paralysis of the hind legs, blind-
ness, and deafness. Black teeth and spongy gums, with fretor of
breath, were common in smokers. An affection of the tongue and
epithelioma of the lips was common enough in smokers. Tobacco
amaurosis was too well established to be denied ; and Mr. Critchett
alleged that the wealthier young men of this day very frequently injure
their sight grievously by their great smoking. Palpitation of the
heart was common among smokers and chewers, as well as paleness,
and occasionally intermittent pulse. Decrepitude came far too quickly
upon great smokers; and Dr. Drysdale attributed, in some cases, the
occurrence of rickety children to the use of tobacco by the male parent.
Brodie said of tobacco, that it tended to make the race degenerate.
Sir William Jenner said smoking tended to produce palpitation, prolapse
of the rectum, and impotence. Miller and ] oily alleged that chronic
tobacco-poisoning caused palsy and insanity. llertillon had shown that
smoking was most injurious to the functions of the brain in youth.
Kostral showed how many diseases are produced by tobacco in the
Austrian State Factory. Fortunately, said Dr. Drysdale, our European
women do not smoke. They p"refer good breath and clean teeth to
fretor and black stumps, and do not like to become dreamy, nonchalant,
and fractious, like the chronic votaries of the pipe or cigar.
On the Evils of .ilfedical 11Im undertaking the Duties of Nurses. By
A. FREER, 1\1. R. C. S. Eng., Stourbridge.-The growing disposition of
the richer classes to have their medical attendants to nurse them
during acute but ordinary illnesses, should be watched with regard to
the interests of both doctor and patient. \Vhy in such illnesses should
the medical man assume the duties of a nurse? If the attendance of
a medical man be demanded during several nights, this should be given,
not by him in charge, but by some one free from the anxieties of
general practice. The surgeon, who lias been away for a time, returns
to the bedside able at a glance to appreciate changes. Absence makes
the eye grow clearer; and the first look at the invalid after a night's
absence must not be lightly foregone. If the medical man stay in the
house of the invalid all the time, the friends are tempted to put undue
pressure upon him to prescribe some fresh remedy at every change for
the worse. Perhaps, in the night, the patient is stirred up anew to receive
a fresh attention. If the medical man suggest nothing more, disap-
pointment is fel~ by the friends. They do not understand, as he does,
that time itself is a remedy without which all others may be in vain. It
is a happy thing that improved knowledge of disease is to us increased
power; for, as luxury advances, people are becoming more impatient
of the restraints of illness, and expect mare from medical men than
they used to <lo. But these must not be willing at every call to come
down from the hill of observation into the battlefield to do the work of
subalterns ; but if this be forced upon them to a greater extent in the
future, it i~ to be hoped that the notions of the public as to remunera-
tion for unnecessary detention keep pace with such serious claims.
The Training of Nurses in Provincial Hospitals. lly EDWARD
WATERS, 1\1. D.
Friday, August 6th.
The Section met in the Chemistry Class·room; Dr. LYON PLAY-
FAIR, M.P., in the Chair.
GROUP C.-GENERAL SANITARY ARRANGEMENTS : DRAINAGE :
WATER-SUPPLY: VENTILATION.
The Sanitary State of Rome. By LAUCHLAN AITKEN, M.D., Rome.-
It was, he said, useless to deny that the sanitary reputarion of Rome was
of the worst possible character ; and it had been, and was, so much the
custom to write and speak of its unhealthy state, that they need feel no
surprise if many still associated the name with ideas of danger or dis-
ease. Many visitors came under the influence of that feeling; he
might have said nearly all, except perhaps a few sentimental young
ladies, who found a gloomy satisfaction in believing that all the trea-
sures of antiquity and all the wealth and beauty of nature to be found
there, could only be visited at an amount of risk which made them
think their doing so little less than heroic. Proceeding to inquire if
this distrust were thoroughly warranted, he referred to the excessive
mortality in Rome in 1872, when the death-rate was 37. l per rooo, due
to an epidemic of small-pox which had spread over Europe from the
war-stricken provinces of France ; a great increase in the deaths from
diphtheria and croup, the effects of the inundation of the Tiber at the
encl of 1870, when two-thirds of the houses were flooded; and the over-
crowding of the poorer quarters, due to the influx of labourers and
artisans, who eagerly poured into the newly constituted capital, in the
hope of better wages and steady employment. llut, since 1872, there
had been a gradual improvement. The effects of the flood had ceased
to tell on the death-rate ; better accommodation had by degrees been
provided for the new-comers. \Vork had been easily got by all steady
men, wages had been high, and provisions, though dearer, had not
attained a price which seriously interfered with the poorer classes ; and,
since the advent of the Italian government, the city authorities had
borrowed largely, and spent money to improve its sanitary state.
 . 272 THE BRITJSH MEDICAL ')OURA'AL.
Among other things, the drains in the so-called English quarter had
been thoroughly repaired or entirely rebuilt. The cleansing work was
helter performed, anrl, if the scavengers still seemed to take things
rath~r easil)•, yet e\·cry one who knew Rome only a few years ago now
readily admitted how much pleasanter to the eye and nose it had be-
come. Outside the city walls, too, there had been progress, though
i:ot to a correspo11ding extent. Garibakli':-; plans were not imprac-
t1cablc, am! would prubahly have the dc>ired effect. l\!eantime, many
of the proprietors were engaged in planting the Campagna with fast
growmg young trees. From the reports issued by the Statistical Office
at the Capitol, it appeared that, in 1S72, the proportion of deaths u,
the population was 40. 5 per rooo; in 1873, 34. I ; in 1874, 33.9;
and for the first fi,·c months of this year, 35. r. Those figures, how-
e\·er, presented a fictitious mortality, as they inclurlc1l in the returns
from the hospitals end city the deaths of many persons not belonging to
the community of l-tome. After mal<ing- the clue deduction, the 111or-
tality assumed very different proportions, being, in 1872, 37.1 per rooo;
in 1873, 29.1; in 1i374, 26.2; an1l in the first five months of 1875,
29. I. A great part uf tLe deaths among those ,,·ho hacl no fixed resi-
dence in Ro1nc occurr~·d in the hospit:-ils; and, inclced, the admissions
of immigranh from other provinces of Italy into those institutions
;:reatly exceede1l thcbc of the poorer classes of I-tome. The patients
111 the hospitals hdonr.;ccl rnamly to the central ancl southern provinces
o.f Italy,_ the 1nnjority being peasants, who arrivccl at fixed seasons to
till the Campagna cir lo reap the harvest, while others \\'ere masons or
bricklayers, who c;-.tabli:-;.hcd themselves in Rome when work 'vas
plentiful, but who ],ad not yet been i11cluclecl in the population. The
fluctuating population "·as almost entirely male, ancl, as the occupations
of the pea~ants expo:-:cd thc1n to the n1:i.1aria during the worst season,
the deaths were enormous. They were ~aicl to be 6 per cent. annu:i.llv;
hut that was probably un1ler the trnth. J'\ o doubt also the unhealtl1y
state of the hospitals had much to clo \\'ith the excessive mortality; the
deaths in the hospitab, indeed, amounted to nearly half the mortality.
Although the death-rate in the hospitals of those not belonging to the
~on11nunity was high, it clid not scen1 to be so among other strangers
111 the city. H.eferring- to Roman fever, he ren1arkcd that a great n1nny
~leaths were regi,tered from this cause \\'hich "·ere really not caused by
it._ IIe had nen;r :-:cen any case among visitors to Ro1ne during the
wmter months which could be so clcscribecl. In conclusion, he said
that a .modern Roman had nearly as goocl a chance of life, and was no
more likely to clie from a preventable disease than the citizens of Edin-
burgh; and it was pos,ihle that, by the statement he had made, part at
least of the fear of a Yisit to the Eternal City might be dispelled.-
The PREStDE:\T sai1l that perwnally he had not a Yery good word to
say for Rome. He \\·ent there, and on the third day took that fever.
During his con\·alesccnce, he thought a good deal as to what was the
cause of the fever. I le did not know that he came to a better con-
clusion than anyone else. But one thing struck him. In ancient cities,
such as Rome and Jernsalem, the dif•ris of many thousand years, which
had accumulated ancl raised the level of the surface, contained a large
r1uantity of organic remains, \Yhich lay clormant until excavations \\'ere
made, when the oxygen of the air commenced an incipient putrefac-
tion, and prod ucerl malaria. c\t all eYents, he knew exactly the time
when he was struck. It \ms \Yhi!e looking '1t some new excavations
which were being made in the Palace of the Cxsars. He thought it
would be very interesting if Dr. Ailken were to obtain an instrument
for ascertaining the exact amount of organic matter in the air by
means of permanganate of potash, ancl examine the air before an exca-
vation had con111H:nccd, nncl after it was in progress. So111e interest-
ing conclusions coulcl be obtained in that way. The enormous mor-
tality among workmen in the hospital had been mentioned, and it was
quite possil>le that the \\'Orkmen were stricken do\\'n while excavating
ruins, n1aking new ~ewers, or taking out the foundations of new· houses.
-Mr. \V. J. CooPEK (Richmond) pointed out that great mortality also
occurred in J erusalcm among the Jews. The sewage of centuries had
sunk into the d/f!ris, ancl, when it was clistu,becl, malaria set in, an1l
the mortality \\·as wry great in consequence. In 1854, an old clay
pit was opened in Hruacl Street, London, which emitted a Yery foul
smell. Cholera came shortly afterwards, and Golden Square, adjoin-
ing, was almost clepopulated.-Dr. GRJGOR (Rome) thought the un-
healthine>s of Rome as a winter rc,idence was very much magnified.
The community \\'as small, and any fatal case made a great noise. I-le
was satisfied that Rome had as little typhoid feyer as Edinburgh, or
any town he knew, in proportion to the population. He did not
think a great deal of typhoid was generated in Rome; what they had
was an ague or malarious fever. Typhoid was imported from other
citi~s. He believed that the malaria among the workmen was clue,
not so much to excavations as to the poor constitutions of the men,
caused by their poor living and wretche1l loclgings.
[August 28, 1875 .
On the Sanitation ef I£ouses, especially with nfermce to Drainage.
By \V. EAssrn, Esq., C.E., London.-The evils of improper drain-
age "·ere best observed in houses that had been from time to time aclclecl
to. One was then able to trace the first awakening up of the inmates,
when the patrimonial cesspool had filled up and choked the drains.
\\'hen this happened in villages, all that was clone was merely to par-
tially empty the receptacles ancl clean out the drains. And when this
ha<! occurred several times, a new dumb-well was sunk and the drains
led into it, the old pit being CO\'Crecl up with a stone. It was cheaper
to do this than to fill it up; and, besides, this procedure did not neces-
sitate the absence of the family. It was the same in towns, and lately
l\! r. Eassie laid bare in a \Vest Encl London house three cesspoob
which had been dug in proximity, and abandoned in rotation as they
filled up \\'ith ordure and tilth. Fonr cart-loads of night-soil were re-
mO\·ed, \Yhich coukl not have seen daylight for half a century. The
reason why these ancient nuisances were found inside houses in towns
and cities was not because they could not be accommodated outside the
house, but because the slops from the kitchen arnl bath and laundry
wastes were insufficient to flush the more solid wastes outside the walls.
In nearly e\·ery case, too, the drains were of brick, laid with uneven
bed, and through the joints of which the fluids percolated. For in-
stance, " cottage was drained into a cesspool in the kitchen, and, when
tlrnt was full, another was dug, until the place was honeycombed with
them, the subsoil saturated, and the well poisoned. A common privy
was used in the yard, and this performed the same evil functions.
By-and- bye water-closets were introclucecl, and earthen pipes, and the
cesspool for these was dug in the garclen, with a lower one for an overflow,
and both cemented do\\'n air-tight fashion. There was no ventilation,
except through the trapping-water of the syphons. Drainage into a
cesspool was not nece>sarily dangerous, provided only that the waste·
pipes of the sinks clcliverecl outside over a trap; provided, too, that the
soil-pipes were carried roof high, and a foul-air withdrawing-cowl fixed
upon them, all ,,·oulcl be well. It might, in some cases, be absolutely
necessary also to ventilate the cesspool by an upright shaft, or a venti-
laiing charcoal trap in the stone cover; and it might even be wise oc-
casionally to ventilate the march of the drain. \Vhere a common privy
was used, an earth or ash-closet ought to replace it. \Vhere a parish
sewer was put in the main road, and the valne of the land enhanced so
much as to make it worth while to enlarge a building, sometimes half
of the house was drained into the sewer and the other half into the old
cesspools. The old cesspools hacl not, however, been dug up in the
basement of the house nor the urine catch-pit in the stables. It was
very easy to so arrange the plan of a house that the whole of the wastes
might deliver immediately outside the house, and to have nothing but
the outside wall between the water-closets, lavatories, and sinks. \\'hen
it was advisable to clrain the basement, it could be disconnected from
the main road by interpo,ing over the junction a ventilating shaft. The
sinks and lavatories should all deliver over an open chamber. The
walls of a house should be built hollow, and protected from rising clamp
also by a proper damp-proof course.-Dr. CARPENTER (Croydon) said
there were three canon laws that ought to be observed with reference
to the disposal of sewage-( r.) That in sewers in connection with
houses, stagnation should not be allowed; (2.) that there should be
free ventilation, the air, howeYer, not being allowed to pass inside the
dwelling-house; and (3.) that there should be no communication be-
tween the sewage and the water-supply.
011 Mortality in relation to Dwellings.· By GEORGE Ross, M. D.,
London.-Dr. Ross commenced his paper with questioning the correct-
ness of the ordinary statement that " the mortality of a population is
in a ratio to its density", and affll'med that "high density is not neces-
sarily a cause of a high mortality". He pointed out that life in great
cities might be made as healthy as in the best regulated villages, if the
authorities would use the resources at their command. There need he
no stagnant water, nor festering heaps of dirt, no decaying vegetation,
nor other nuisance in cities, if proper cleansing were systemallcally re-
sorted to ; ancl houses might be built, even for the humblest, upon
plans that would secure ample ventilation, and promote the health of
the occupier;. Ile then clescribecl the condition of houses in towns as
they now exist, an<! pointed out their characteristic evils ; affirming his
belief that the chief cause of the high mortality of an urban population
is the bad construction and squalor of their homes. The new Act for
the improvement of the dwellings of the working classes would, it was
hoped, remm·e the worst of these evils. Dr. }{oss then explained a
series of tables to show the direct influence of unwholesome houses in
producing disease and premature death. He gave a list of thirty-two
streets in St. Giles's district; and showed that, in one street at the top
of the list there was, in the course of a year, one death in every house
from diseases caused by filth and bad ventilation, viz., zymotic diseases,
tuberculous diseases, and asthenic bronchitis. From that high average,
 ·August 28, 1875.] THE BRITISH MEDICAL JOURNAL.
there was a gradual declension until, in a sqnare at the bottom of
the list, there was only l death in 41 houses from the same diseases.
Again, as regards population, Dr. Ross showed that the mortality
from the same diseases was more than thirteen times greater in the
street than in the square. In Chapel Place, a .court of small cot-
tages, the death-rate in 1870 was 69.7 per l,ooo, and all the deaths
were caused by the diseases named. In Queen Street, the death-
rate was 48. 7 from the same diseases. The death-rate of other places
was given, and Dr. Ross described the peculiarities of the several courts
to account for the difference of mortality. The mortality in Chapel
Place from zymotic diseases was 16.4; in Queen Street, 9. 7; in Church
Lane, 8.4; in Dudley Street, 6. z ; and in \Viki Court, 5.6 per rooo
living. Dr. Ross then compared the death-rate in three blocks of
buildings, under the management of the Society presided over by Lord
Shaftesbury. These blocks were similar in size, had the same careful
attention, and were occupied by a similar class of people, and only dif-
fered materially as regards their structure and surroundings ; :rnd he
showed th'1t, in one year, the death-rate was, in one block of the model
houses, 4.6 per r,ooo; in another block of adapted houses, 18.2; and
in the third-a very had old block, but allaptecl according to the pre-
valent notions for promoting- health-36.5 per r ,ooo. The sanitary
condition and mortality of portions of the \Vhitechapel District were
then detailed, the facts being collected from Mr. Liddle's Reports.
The results were similar to those in St. Giles's clistrict. The wretched
habitations in Farthing Alley and Rose Court were described-houses
consisting of two and three rooms in narrow courts, without proper
sanitary conYcniences, an<l without the possibility of ventilation. Dr.
Ross stated that there were many acres of this kincl of property in
\Yhitechapel. Dr. Ross then reverted to his original proposition that
mere density was not necessarily a cause of disease, and illustrated his
argument by a reference to the high density of population in model
dwellings, and the associated low death-rate. lle also stated that
already in some parh of the metropolis the density ranged from 600
to 2000 persons to the acre. The difference in the mortality was caused
chiefly by the difference in the construction of the houses and sanitary
arrangements. It \ms not density, but dirt, that had to be guarded
against. The defects of site, construction, and arrangement, that make
houses unhealthy, were then briefly stated, strong emphasis being placed
upon the evils arising from the bad foundations of houses. Dr. Ross
insisted that all dwelling houses should be built on concrete or other
impermeable material; as all porous soils, including gravel, let in the
water, aml made houses unwholesome. Brick houses, after a certain
period, became unfit for habitation on account of the absorbing power
of the brick, which retained miasma tic poisons, and kept up a succession
of attacks of Lymotic diseases. J\Iany of the remarks in this part of
the paper were eYidently made in allusion to the powers for condemna-
tion gi \'en to medical officers of health in the new Act of Parliament.
Dr. Ross concluded his paper with a list of suggestions in respect of the
sanitary requiremcnh to be observed in the erection of new d\\·ellings
for the working classes.
Sauilaiy Remarks"" Trap and Soil-Pipes. By A. FERGUS, J\I.D.,
Glasgow.-Dr. Fergus said he had for some years been investigating
diseases connected with excremental pollution ; and, at the Birming-
ham meeting of the Association, he had clrn wn attention to the danger
arising from decayed soil-pipes. Finding that the perforations were
al ways in clry portions of the pipes, and ma,Je from the inside, he con-
cluded they were caused by sewer-gas-an inference sustained by che
mica! analy:;is of the powdery corroded matter, and by the fact that
\'entilated pipes lasted longer than close ones. The specimens he ex-
hibited had all been well trapped ; and as tension sufficient to force gas
through the trap \\·as too rare to account for such an action, he was
forced to the conc:n,ion that the gas \Yas either generated in the trap
itself, or was absorbed by 1he water at the outer ernl, '""' giYen off at
the inner encl, or that both of th"cse things took place. That diffusion
by the latter means was likely-indeed, inevitable-he had proved by
frequently repeated experime1'ls with model traps, when a little gas
(without pressure} on one side, was always found to diffuse ibelf through
the water, and, in a very short time, to indicate its presence by chemical
tests on the other side. This happened whether the gas was light or heavy,
and the most thorough ventilation only made its passage a little slower.
IIe had recently been giving increased attention to the other source of
gas-viz., generation in the trap itself. He invariably found that part
of the L>cces floated on the surface of the water on the house side of a
trap or cesspool. Flushing only agitated without removing them, and
then they decomposed until dissolved. The gas rn generated must
either pass up the rain-pipe (if connected) or into the house; and was
more likely to do the latter, on account of the higher temperature. He
gave minute particulars of a representative case in a good locality in
the West Encl of Glasgow, where typhoid fever, casually introduced,
273
was spread in this manner. The true sanitary remedy was that no ex-
creta! matter should be allowed to pass into the cl rains at all ; it should
be dealt with separately, and, within twenty-four hours of being voided,
should either be returned to the earth or subjected to chemical or other
action, rendering decomposition impossible.
Oil the Smitmy .!mp1o<N111e11ts of Country Vi!la,~ts. By G. \VIL-
SON, M.D., Leamingt.on.
On the Compamtive llferits of the lVater Carriage a11d JJ1y Systems of
Set.l}(lJ.jt! ]rum a Sanitar)' and Econo1nical I'oint of F''/1..."W. By G. A.
KENYON, ;-,r. B., Chester. -This paper set forth the conclusions
arrived at by an impartial inquiry into the respectiYe advantages and
disadvantages of \\'::tier-closets, z•ers11s dry methods of removal of ex-
crement for urban communities. These conclusions were, in short, to
the effect, that if remoYal at intervals of one week or less is to be
insistell on, then the only advantages that can be pleaded in favour
of dry systems is, the saving of the water that would otherwise be
required to flush the closets ; and that the c1uantity of water thus
savecl may be taken to be equal to one-seyenth or one sixth of the
smallest amount needful for the convenient satisfaction of the other
requirements of the community ; an amount that would seldom be of
serious importance. The experience of towns (CO\·cntry, \Vanvick,
Bristol} in which the use of water-closets is universal, was quoted to
show that no serious difficulty is encountered from misuse by tlic poorer
inhabitants. Tbe danger of introducing sewer-gilses iuto houses inay
be entirely avoided by keeping the water-closets, like all other closets,
actually or virtually outside the houses. Although recently a great
amount of success has been met with in disposing of the contents of the
pail-; in one large town, yet the working expenses are so great as to
exclude the idea that, on this account, the pail system has any advan-
tage over water·clc»ets; \\·hilst there is, as a matter of fact, a good
deal of nuisance connected with their use, and not the same security
from the risk attending the deposit of infectious evacuations or dis-
charges \Yhieh is afforded by the water-closet. If removal once in three
months were sufficient, there would be attainable, at a smaller
expense, a great improvement in the oh! state of things in a town;
by filling up all underground middens or cesspools, excluding rain,
distributing ashes, and so arranging, that any excess of 1noisture, su.:h
as would be occasioned by inadvertently emptying slops therein, should
escape along a surface channel to the yard-gully. Thus, there need be
no drain inside, and no ashes could get into the sewers; nor would the
interior remain wet; and there would be a warning· afforded which
would tend to prevent a repetition of misuse.
Tk: Draillag.: and oth,r Sanitm)' Conditions ,,f Rural Districts. By
J. A. D.\\'E:'\PORT, Esq., Nantwich.-In the course of a paper, in which
the question of rural drainage was dealt with, J\Ir. Davenport said
that, of the systems of dealing with house-slops and liquid refuse, one
which seemed to answer in the di,,trict with which he was connected,
\\·as that of subirrigation carried out either in the garclens or fields ad-
jacent to the dwellings, sometimes in connection with a little tank, and
sometimes without ; where there was no tank, the slops were thrown
to a trapped grifl, below which there \\'as a strainer to preYent any
matter from passing, likely to choke the drain; \\·here it was necessary
to prevent pollution of the soil, larger sanitary pipes shoukl be used;
but, where the liquid was dealt with, common pipes were used (some-
times with sockets}, and at every two or three feet, spur pipes branched
out for three or four pipes' length ; these drains were placed ten
or twe!Ye i11ches below the surface, and tl1e liquid soaked from them
into the soil. It was necessary, however, to provide subsoil drains at
as great a depth as possible in order to relieve the soil of the excess of
purified water; sometimes it was preferred to allow the water to drain
into a little tank first, propedy phced, to be kept for garden purposes;
and then the O\·erflow \\·;,s simply dealt \\·ith on the above system.
Sometimes he had utili,;ecl a deep ditch, running the o\·erflow irrigating
drain parallel to it, and allowing the liquid to filter through the inter-
vening soil. If the upper drains should become choked, it would be
but a small matter to take them up and relay them ; but he had in his
district a block of eight or ten houses that had been drained on this
system for two years past, and all was working well up to the present
with no signs of ch<lking. i\Iost of the work was roughly clone, and
under conditions rendering a good result a matter of some doubt. Still,
so far, it was as sati.sfactory as might be expected. The difficulties in
persuading and arranging as to this particular system hall been great ;
for ordinary people did not quite comprehend it. The only principle
that he had considered· it safe to act upon, was to deal with all foul
liquicls by the soil ; get them properly on to it or through it by some
means as quic'.<ly as possible ; and, in suggesting any rural drainage,
he always kept this encl in view; and the system sketched out, or some
little variation of it, which might be frequently necessary, looking at the
varying conditions under which such work had to be carried out, would
 THE BRITISH MEDICAL JOURNAL.
generally be found to furnish a fair solution of the difficulty. The
ventilation of the drains should in all cases be insisted on. Field's flush
tank would be a great addition to any system of garden subinigation.
Greater difficulties with these subirrigating systems might be experi·
enced where the soil was excessively stiff, but the ashes from the house
and the refuse from the garden burnt, together with other substances
tending to lighten it being mixed therewith, would in some degree
tend to remove the difficulty. Probably for villages, etc., no better
method of dealing with their sewage could be adopted than that pro-
vided by the automatic sewage meter-tank.
Drinki11lra11d Table lVaters. By C. H. BARTLETT, Ph.D., F.C.S.,
London.-The paper commenced with remarks on the necessity of a suf-
ficient supply of aqueous fluid for the due performance of the functions of
animal life; and the fundamental part water performs in the transforma·
tion of food into the animal tissues and in the elimination of the waste
products of the system. The agency of water in the processes of fer-
mentation and decomposition was then considered ; and the advantage
of accurate observation of the quantities imbibed in health and disease
was pointed out. The author then commented on the value of micro-
scopic research as leading to a new method of pursuing medico-chemical
investigations which might pave the way to the identification of the
specific poisons of infection. He then noticed the precautions required
to prevent drinking water from disseminating disease. Chemically pure
water was unattainable and unnecessary. The geological sources of
water-supply, as affecting its wholesomeness, were considered ; and the
reason was given why the water from surface-wells and alluvial soil is
generally unfit for drinking. The nature of different organic impurities
in water was described ; and the means of discriminating those which
were dangerous from others less objectionable were mentioned. Re-
marks were made on metallic poisons in solution, and on the fallacy of
the usual standard of estimation. Autumn was the period when well-
water was most liable to dangerous impurities. The author described
the means of prevention of lead-poisoning, by the use of tin piping and
a new filtering medium which removed both lead and organic matter.
The dangers of common aerated waters made with impure chemicals,
and the necessity for a great alteration in the ordinary apparatus for
their manufacture, were pointed out.
On Ventilation, wit!t 1lfodel of Apparatus. By G. GOLDIE,
L.R.C.P.Ed., Leeds.
The Exfmse cf Ventilation and ~Var111i11g as Sanitary Requirements.
By JAMES A. RUSSELL, M.B.
On the .1£i11eral Constituents of Drinking· TVater. By J. A. 'VANK·
LYN, Esq., London.-Mr. 'Vanklyn said that within the last ten years
the problem presented by the organic matters in water had been
solved. Chemists would do well to return to the inorganic materials
in drinking-water. It was a well established fact that, by filtration on
the large scale, the organic matter in drinking-water might be so far
removed that the water might be made to reach the standard of purity
attained by good drinking-water; but, if there were objectionable
mineral matter in the water, there was no remedy but to change the
source of supply. To this statement, however, there was an exception
in favour of the Clark process, whereby an excessive charge of car-
bonate of lime was reduced. It might be asked, Do not the mineral
matters taken in food so far outweigh that in drinking-water as to re·
duce it to insignificance ? An inquiry into the mineral matter actually
present in the food led to a decidedly negative answer. Bread contains
the mineral matter of the flour and the salt commonly used in making
it. Assuming that one pound of flour is consumed by an individual in
a day, the mineral matter supplied by the flour will be about 50 grains;
and these 50 grains comprise 25 grains of phosphate of potash, 12
grains of pl1osphate of magnesia, a little phosphate of lime, a little
silica, etc. To the pound of flour the baker adds about 70 grains
of salt. The quantity of water drunk in all shapes during the clay may
be set down at about half a gallon; and those Londoners who drink the
water of the Thames will, therefore, take daily 8 or IQ grains of
mineral matter derived from the drinking-water. Putting on one side
the common salt, which was artificially added, the mineral matter of
the food did not by any means overwhelm the mineral matter in the
drinking-water. The question had often been asked, whether the car·
bonate of lime present in many hard waters might not be needed by
the animal economy. If the only other source of lime were the flour
consumed as bread, there might, indeed, be need for the lime in the
drinking-water. According to the recent analysis made in Mr. Wank-
) yn's laboratory, there is very little lime in flour, one pound of which
contains only I Yz grain of lime. He believed that a comparison of the
mineral contents of the ordinary dietary of a population with the cha-
racter of the water-supply would furnish most valuable information.
The mineral required in the largest quantities by the animal economy
was common salt, at least I 50 grains of which were required daily by a
[August 28, 1875.
man. He believed that salt-famines must occur, and that whole popu·
lations must occasionally suffer from deficiency of that material; and he
once recommended a water-supply with 80 grains of salt to the gallon,
in a case where the population appeared not to get sufficient salt from
other sources. He knew no considerable water-supply to any town in
this country from which any considerable fraction of the daily dose of
salt could be derived; but the various beverages often contain much salt.
Beer, which is notoriously charged with a considerable amount of salt,
was a good example in point. A few years ago, Webb's soda-water
came into great favour; and, when this soda-water was examined, it
was found to contain a large proportion of salt. Apollinaris water was
a highly salted drink. The strange liking which many persons had for
the water of sewage-wells, such water being notoriously charged with
salt, afforded another illustration. Bearing these facts in mind, the
conclusion was, that water-drinkers should add a little salt to the water
-20 to 50 grains of salt per gallon. Passing from the salt and car-
bonate of lime, which might be looked upon as in a sense nutritious,
there were in drinking-water other matters, some of which were not
nutritious, being to a certain degree poisonous, or being medicinal. To
this class Mr. Wanklyn would assign soluble compounds of magnesia.
No water-supply should contain more than a very small proportion of
magnesia; probably the limit should be set at not much over 1.0 grain
(carbonate of magnesia) per gallon of water. In Thames water, he
found o. 7 grain of carbonate of magnesia per gallon ; in the Kent Com·
pany's water, I. 3 grain. A curious example of a magnesian water was
afforded by the St. Ann's Well of Buxton, the water of which, accord-
ing to the very careful analysis of Playfair, contained 4. 7 grains of car-
bonate of magnesia per gallon.
Vote of Thanks to the Presidmt.-Dr. A. P. STEWART (London)
moved a vote of thanks to the President, Dr. Lyon Playfair, whose
presence had done honour to the Section. [Loud applause.] One of
the few real statesmen, he said, sent to the House of Commons after
the passing of the late Reform Bill was Dr. Lyon Playfair, whose
ability was soon recognised by all, and who secured a power and posi-
tion in the House which, he believed, would be strengthened in the
future. Dr. Playfair had been of great advantage to the community,
especially on those matters to which his life had been devoted, and to
whose success he had so materially contributed. [Applause.]
Dr. CARPENTER (Croydon), in seconding the motion, hoped that
Dr. Lyon Playfair would be able to carry out those maxims which were
put forward by the leader of Her Majesty's Government and by the
leader of the Opposition-viz., Sa11itas sanitat11111, omnia sanitas; and
Salus populi suprema est !ex [applcwse]-for hitherto what had been
introduced had been defective to a considerable extent. [I:lear, hear.]
Dr. LYON PLAYFAIR said it had been to him an immense pleasure,
and a great aid and encouragement, to have met so many Medical
Officers of Health from different parts of the kingdom; because, although
they had corresponded and co-operated together, still the presence of
so many gentlemen interest~d in this great subject-which the leader of
the present government had justly said was the great rnbject of the
future-encouraged a legislator to go on with his arduous labours ;
because he felt assured that there were in the section practical men who
could give practical suggestions which would enable this subject to be
forwarded. [Applause.]
s E c TI 0 N E.-P s y c I-I 0 L 0 G \".
TVednesday, August 4th.
THE President, Dr. W. H. LOWE, delivered an address, which was
published at page 176 of the JOURNAL for August 7th.
The Disorders of Speech in Insanity. l3y T. S. CLOUSTON, M.D.,
Edinburgh.-A discussion ensued, in which Dr. White (Aberdeen)
and Dr. A. Robertson (Glasgow) took.part.
Observations on the Unilateral Fhenomma of Mental and Nervous
Disorders. By ALEXANDER ROBERTSON, M.D., Glasgow.-After
some preliminary observations, unilateral mental phenomena were first
considered. These consisted of illusions and hallucinations, and pos·
sibly also of the peculiarities supposed to be due to the separate and
independent action of the hemispheres. The observations of French
writers were specially noticed. Cases of one-sided hallucinations of
hearing were quoted from Gall, Griesinger, and Schroder van der
Kolk. But these cases appeared to be nearly exceptional in the expe-
rience of these observers. The writer then submitted the results of
his examination of 250 insane patients, both in respect of these and
other sensorial or psycho-sensorial disturbances. Of thirty-four pa-
tients who entertained clear and well-defined illusions or hallucinations
of one or other of the senses, in five "voices" were heard only in the
left ear, and in five others in the left ear more than the right ; in one,
they were audible in the right ear alone ; and, in two, they were stated
 August 28, 1875.] THE BRITI.5H MEDICAL JOURNAL.
to be more distinct in that car than the other one. The disorders of
the other senses were then referred to, and afterwards details of the
cases of unilateral auditory hallucinations were given. The phenomena
were most apt to occur in the milder and more ephemeral forms of
insanity, and particubrly when it had been caused by strong alcoholic
liquors. The frequency with which the hallucinations were associated
\\·ith the left ear was very striking, and it was pointed out that the
cases quoted from the above named authors were also on the left side.
The pathology of the phenomena w.1s then considered at some length,
and also the indications derived from modern research in the anatomy,
physiology, and pathology of the nervous system as to their ana-
tomical seat. The seeming dual action of the hemispheres was then
illustrated. Thereafter, unilateral motor phenomena were discussed,
the observations being restricted to the conn1lsive cla"; and a number
of conclm;ions were stated, some of which were published by the writer
in I 869. First, convulsive movements may begin in different parts of
the body in the same case, even though there is no reason to think
there is any appreciable change in the cerebral lesion. Second, in
unilateral convulsion,;, the so-called bilateral muscles are often impli-
cated, but the t\rin muscles of the otherwise sound side in most cases
do not contract so firmly as those on the side first convulsed. The
physician may, therefore, often ascertain for himself in a case of general
convulsions the side on which the convulsi7e movements first began
(and, consequcntJy, the hemisphere ,1ffected), by simply grasping the
limbs of the two side>, arnl comparing the degree of firmness of their
respecti1-e muscles. Thirdly, there may he alternate conjugate deviation
of the eyes during the same convulsive seizure. Fourthly, as a ~eneral
rule, the higher up the lesion is situated the more apt the convulsions
arc to become bilateral. Fifthly, when convulsions begin on one side,
there is frequently a distinct and sometimes a prolonged interval before
consciousness is invoh-cd; and it is occasionally retained throughout
~he whole seizure. Sixthly, there is a decided increase of temperature
m the convulsed mcmlicrs. All these conclusions were illustrated by
cases. \Vith respect to unilateral sensory phenomena, it was sub-
mitted that there seems less disposition for the "irradiation of sensa-
tions'' from one to both sides, than for the extension of one-sided into
general connilsions. The greater regularity of the motor than the
s~nsory symptoms was also dwelt on and illustrated. In surveying the
cldferent classes together, it was observed that one-sided clisorclers of
motion and sensation had their analogues in unilateral halluciriations,
and just as the partial might become general in the one case, they might
also clo so in the other. A striking illustration of the gradual merging
of illusions of vision into insanity \ms submitted. Lastly, some ob-
serrntions "-ere made on the irregularity in the order of succession of
these phenomena as compared \Yith normal physiological sequences.-
III. Dcruv (Paris) referred to his own experiments on the effects of
cauterising one cerebral hemisphere, in which he hacl found paralysis
of the same side of the body as a result; while a subsequent cauterisation
of the opposite hemisphere appeared to have a counteracting effect, the
paralysis then clisappcaring.-Dr. Clouston, Dr. Yellowlees, Dr. Deas,
and Dr. Bramwell, continued the discussion.
1\'<'lcs of an C1111sual Ca.«' of E/';!,'}sy. By P. llL\URY DEAS, llI.B.,
lllacclesfiekl.-This was a case of epilepsy, complicated with mania, but
also presenting some unusual and anomalous symptoms, occurring in a
strong and apparently hcalthyyoung1rnman. The epilepsy had existed six
years. Before that, she was subject to "aggravated hysteria". Maniacal
symptoms first showed themselves eight months ago. She was under
treatment in the Northampton Asylum for four months, and in the
Cheshire County Asylum for the last six weeks. On admission, the
left foot was found to be contracted ancl distorted, exactly like a bad
case of talipes varn>o The patient, who \YaS very rational at times, said
she had a bad attack of fits last Christmas, while in service, and when
she came to herself she was in the union, and her foot clisto1 tecl as it was
now.. The day of her ~drnission she hnrl several fits, and the following
cvenmg hacl a succession of several fits from 7 P. M. to 4 A. ~r. The
noticeable points in the fits l»ere: r. Violent rhythmical movement of
the }1cad fron1 side t\) ~ide, to the number of one hundred a n1inute, and
attended by a peculiar short re:'piration, like a bark; 2. Tonic spasms
of the muscles of the limbs, \l'hich \Ycrc strongly ftcxecl; the spasms in
about three minutes extending to the trunk, and ultimately producing
actual opisthotonos; 3. Increasing congestion of the face and neck
until, at the maximum of the spasms, the face assumed the characteristic
epileptic lividity, with complete closure of the glottis ; when, just as
choking seemed imminent, sudden relaxation took place, followed by
stertor, hlo\Ying respiration, and foaming at the mouth; 4. After the
fits had lasted some time, the right foot was observed to be becoming
contracted during the spasms; and by the morning it was permanently
distorted similar to the left one. She became maniacal after this for ten
clays, with fits at intervals. During one series of fits, the left hand
275
became contracted and distorted also, but came right in a few days.
The treatment consisted of stimuiating injections, bromide of potassium,
and blisters to the nape of the neck. The most interesting point, perhaps,
in the case, \Yas that, under chloroform, the contraction of the right foot
was reduced. A splint was subsequently applied for a week, and now
the limb was as well as ever. The left foot had since been treated in the
same way. It was already much improved, but, from the longer con-
tinuance of the contraction, the result in this case must be more doubt-
ful. The questions arose, Was this a case of true epilepsy? Could
it be a form of hysteria? or had the "aggravated hysteria", from
which she had suffered, gradually developed into epilepsy? or was it
probable that there was organic disease? Dr. Deas was led to think
that the case must be classed as one of epilepsy, from the following
considerations. I. There was an undoubted "discharge" during the
fits. 2. The patient had a sensation or "aura". 3. There was com-
plete unconsciousness during the fits. 4. There were closure of the
glottis, venous congestion, frothing at the mouth, and stertorous breathing.
5. There were none of the ordinary signs of hysteria. The patient
complained much of pain in the head, especially in the intervals of a
series of fits; she-sometimes asked to have it cut open, or that she might
be killed. Dr. Deas thought it possible that there was a source of irrita-
tion in the brain of an organic nature, but whether of the nature of
deposit, tumour, or other change, it was impossible to say. This view
was consistent with the marked predominance of tonic spasm, and the
prolonged contraction of groups of muscles.
Emotional A/'hasia. By D. DE HERDT HOVELL, F. R. C. S. E., Clap-
ton.-This affection, which might be distinguished from that more fre-
quently bearing the name, by being usually of temporary duration and not
the result of organic disease, was illustrated by the case of a lac!, sixteen
years of age, who, with an interval first of six, and next of eight weeks,
lost the power of speaking, but not of thinking or writing; on the first
occasion for twenty-four hours, on the next for forty-eight, and the third
for one hundred ancl twenty hqurs. IIe recovered perfectly each time.
The attack was brought on, in the first instance, by fatigue of speech from
prolonged effort of talking, combined with excitement and anxiety. It
was contended that this was an instance of aphasia proper, i. e., accord-
ing to the Lexicoi:, of speechlessnes,, from fright or emotion, and that the
disease to which the name is usually applied \rnul<l be more properly
described by aphemia, if that were a classical word, but, that not being
so, by the aphasia alactica of Dr. Ogle. In explanation of the symp-
toms, it was assumecl that the vaso-motor nerves were the seat of the
disordcr.-A short clebate followed, in which Mr. Lennox Browne,
])rs. Down, Gairdner, and Clouston, took part.
Thursday, August 5th.
Statistics of L1111a;y in Town and Country. By JOHN SIBBALD,
M.D., Edinburgh.-Dr. Sibbald exhibited several tabular statements
illustrating the statistics of lunacy. He pointed out that the problems
to be solved before these could be properly understood were of
great complexity. The figures which he had collected in the tables
shown were intended to illustrate one branch of the subject. They
showed, among other things, that the number of pauper lunatics in
Scotland persistently chargeable to country parishes is larger than the
number chargeable to towns, being 206 per 100,.000 for the country,
and 177 per 100,000 for the towns. On the other hand, the number
annually added to the roll of pauper lunatics from among the residents
of country parishes is smaller than the number occurring among the re-
sidents of towns, being 35 per 100,000 in the one case, and 56 in the
other. He showed that this is probably accounted for by a large
number of patients requiring only temporary treatment being sent to
asylums in towns, who would be allowed to remain at home in the
country. He adduced arguments and figures to show that the appa-
rently enormous increase of lunacy in late years was only an apparent
increase, and that there is no proof statistically that there is a larger
proportion of actual insanity in the population now than there was
thirty years since.
{/nilateral Conzl/llsions and I/l·1niplt;;;ia, dt'jJ.?udin_:; ujhJJl a cirntlll·
so ibcd Lesion of Cenbral Com!,>luti 'llS. Hy Bnw'r BRA,l\\'ELI.,
111. B., N" e11·castle-on-Tyne.-:\Iary Conway, aged 37, was admitted
to hospital May 23nl, 1875. Eight years ago, she rec<>ivecl a
severe blow on the left side of the head. (The skull was fractured.)
Three years ago, she had four right-sided unilateral convulsions,
brought on, she thought, by fright. For the past three years, she had
felt "pins and needles" in the forefinger and thumb of the right hand,
and had not been able to use her needle as well as formerly. On May
IOth, she went to heel very drunk, and vomited all the following day.
On May Ilth, she had a severe convulsion, and continued to have fits.
A week after the fits commenced, "she lost the power of her right arm
and leg". She looked fifty years of age. The pupils were equal,
 THE BRITISH MEDICAL JOURNAL.
moderately contracted. Iloth eyeballs were turned upwards and to the
left. She lay on her right side. The eyes were partly closed. She
was unable to move the right arm and leg. 'When the mouth was
opened, it was drawn to the left side. She could not protrude the
tongue, which was abraded at its tip and on the right side. She swal-
lowed well; her appetite was good. She was conscious, and could say
several wonls; knew her name and address. Her speech was thick,
and difficult to understand. She could imperfectly localise impressions.
She made no complaint of pain when pricked with a needle. Muscular
contractility and sensibility seemed natural on the two sides. Every
few minutes, she was seized with a convulsion. There were three de-
grees of severity. In the first or slight form, the muscles of the face
and neck were alone affected, in the following manner. Iloth eyes
were first firmly closed, and the right corner of the mouth was drawn
downwards in tonic spasm, and the eyes were next partly opened; the
head and eyeballs were then slowly turned to the right side. Clonic
spasms next occurred in the eyelids (the left being only slightly af-
fected), the muscles of the tongue, right side of the neck, chiefly the
platysma. After a short interval, the clonic spasms became much Jess
frequent. The head and eyeballs were slowly turned to the middle
line; the eyelids widely opened; and the patient presented an animated
appearance. 1:he eyeballs were finally turned upwards and lo the
right; the eyelids were closed, and the patient Jay apparently asleep.
In the second form, the convulsion commenced as before; but the right
arm and leg were affected (in a definite order, not here detailed). In
the third form, the fit went on as in the first and second forms, and then
became general ; the left side being affected in a definite order. The
slight fits occurred every few minutes. The optic disc was large and
pale, in contrast to the surrounding fundus, which was highly injected.
There was a depression in the skull two inches above the left ear.
The diagnosis was acute softening, either from embolism or irritation
~elow the point of depression .. The treatment consisted in the applica-
t10n of cold to the head, bronude of potassium, and nourishment. She
~ied s.omewhat suddenly on l\Iay 3oth. At the post mortem examina-
tion eight hours after death, there was found to be a perforation of the
skull at tl.1e point of depression. A sharp spiculum of bone projected
from the rnner surface of the skull, and pressed upon the cerebral con-
volutions, causing a very limited lesion of the inferior marrrin of the
ascending parietal convolution. There was some softening at this part
and below it. The brain was otherwise healthy. The membranes
were generally opaque and thickened. Dr. Bramwell remarked that
the important points of the case were: 1. The long lapse of time between
the receipt of the injury and convulsions; the convulsions occurring for
a single day, and then being unilateral; the numbness in the forefinger
and thnmb of the right hand for three years : 2. The remarkable uni-
formity of the order in which the various muscles were affected by
spasms : 3. The limited lesion found after death : 4. The fact that the
general convulsions were controlled by bromide of potassium. The
case seemed to confirm som~ of Dr. Ferrier's experiments, proving that
the centre for the platysma 1s the same in man and the lower animals.
It also confirmed the soundness of Dr. Hughlings Jackson's views on
epilepsy (discharging lesion of the cerebral convolutions). It was diffi-
cult to say what was the exciting cause of this attack; possibly the
violent vomiting. The exact cause of death was not ascertained (the
head alone could be examined). There was a decided rise in the tem-
perature of the right side. Rig'.H' mortis came on early (eight hours
after death) in the right side, but not in the left. The bone was not
trephined. It must, however, be remembered that the patient was
recovering. There was no true aphasia.
Two Caus ef ,lficrcaj>halir Idiory. Ily G. E. SHUTTLEWORTH,
M. D., Lancastcr.-The author gave a hrief description of the physical
and mental characteristics of two microcephalic idiots now resident in
the Royal Albert Asylum, Lancaster. Remarking that the case of one
of them had been already referred to in the last edition of" Bucknill
and Tuke'', he proceeded to compare the present head-measurements
and characteristics of that patient with the ;tccount then quoted from
Dr. Ireland's obserrntion in 1871. He stated that, \\'hereas at that
elate the circumference of the boy's head was but 14·'- inches, it was now
14{- inches; and that other measurements showed that there had been
development during the last four years, chiefly of the posterior part of
the skull. The boy, who was eleven years old, was active, observant,
and displayed even evidence of capacity to carry on a train of reason-
ing. The etiology of this case was obscure. The second case described
was that of a boy aged 7, whose head measured onlv 141-inches in circum-
ference. The vault of the skull was of fair propm:tion~, and, in fact, the
head simply seemed to be formed on a very small scale. The child had
a full lustrous eye and fair! y intelligent appearance; and, though pos-
sessing but feeble powers of expressing himself, was very observant and
i nqnisitive. He was of rickety diathesis, the child of parents in whose
[August 28, 1875.
families, which were related, there had been previous mental weakness
and a tendency to phthisis. The mother gave an account of a severe
nervous shock sustained by her about the middle of pregnancy, owing
to her witnessing the fall upon his head of one of her other children.
The author, while stating his general disbelief in the influence assigned
by mothers to such impressions, argued that in this case the malforma-
tion of the head was at least as likely to result from that cause, ao from
the more scientific one assigned by Virchow in similar cases of prema-
ture ossification, to which the rickety diathesis would not be likely lo
contribute. He remarked, further, that the essentially human charac-
teristics of both the cases lent no support to the theory of Vogt as to
the pithecoid affinities of microcephales.
Bulbar Paralysis. By T. S. DowsE, M.D., Highgate.-The author
first raised an objection to the French name glosso-laryngeal paralysis,
and hoped that the German term bulbar paralysis would supersede it,
because it was shorter, and gave a more definite idea of the extent
of the lesion in the medulla oblongata. Ile drew attention to the
etiology, clinical features, diagnosis, prognosis, pathology, and treat-
ment of the disease. Dr. Dowse's practice in the Central London
Sick Asylum had given him considerable experience in this as in
kindred diseases of the nervons system, and, in: opposition to the opinions
of most writers on this subject, he held that the so-called bulbar para-
lysis, although essentially progressive and surely fatal, might be divided
into two classes, direct and indirect. The direct arose from-I. Pro·
gressive interstitial neuritis; 2. Thrombosis of medullary vessels ; 3.
H::emorrhage; 4. Morbid growths; 5. Spasm of vessels. The in-
direct arose from-I. Reflex action from peripheral irritation; 2. In-
hibition from shock to the central cerebral ganglia. Of these varieties,
only one could be considered to come under the term slowly progressive;
the others he looked upon as retrogressive and stationary. Ile detailed
the clinical notes of a case of paralysis of the facial, hypoglossal,
spinal accessory, and glosso-pharyngeal nerves, where speech and move-
ment of the tongue had been lost for more than four years, and which
was cured by the continuous galvanic current. Ile also gave the clini-
cal notes of a case of retrogressive paralysis of the bulbar nerves,
which, in his opinion, was of a reflex nature. Dr. Dowse did not be-
lieve in reflex paralysis of the hypoglossal nerve from diphtheria,
neither did he recognise an hysterical bulbar paralysis of a persistent
character. Dr. Dowse drew attention to one point, which he con- ·
sidered of great importance in treatment, and gave a case where the
man so far recovered as to resume his occupation of a coal-heaver,
through the early administration of fluid nourishment by means of a
piece of elastic tubing passed through the nostril. He said that it was
unjustifiable to trust a patient to feed himself until the disease was so
far advanced that he was liable to choke himself with every mouthful
of food. Artificial feeding was absolutely necessary immediately the
second stage of deglutition became affected. Drugs were of little value.
The administration of steel and cod-liver oil was indicated, and the in-
jection of one-fortieth of a grain of atropine into the. submaxillary
region had in some instances checked the overflow of saliva.
On the .EJ!i·cts ef Vi1rio11s Dis<'llses on the TVe~~Jzt of tlze SeNral Pa1·ts
of the Encephalon, in 2,050 Sane and Insane Adults of both Sexes. By
R. BOYD, l\I.D., London.-The paper was founded on the results of the
necrological registers kept by Dr. Boyd during thirty years in the
St. l\Iarylebone Infirmary and in the Somerset County Lunatic Asylum.
As rerrarcls the sexes, it was found that the average weight of the
encepl~alon was from four to five ounces heavier in males than in
females, and that there was a difference in height of m1 equal number
of inches. The proportions of the different parts of the encephalon,
estimated according to the height in 400 males and 325 females,
insane, were as follows: the average height in the males being 66
inches, and in the females 62 inches.
111alc. Female.
Cerebrum (right hemisphere) .301 .294
" (left " ) .302 .295
Cerebellum .077 .076
Pons and medulla .016 .016
Encephalon .697 .681
The cerebrum was .007 heavier in males than in females, and the left
hemisphere was heavier than the right by .oor in both sexes; the
cerebellum .oor heavier in males ; the pons and medulla alike in the
two sexes; the encephalon .016 heavier in males than in female><.
Inequalities in the size of the two cerebral hemispheres have frequently
been observed, especially in epileptics. (See Jffedicu-Chin11;~icc1!
Tra11sactiu1ts, vol. xxxix.) The heaviest brains have often been tho,:c
of epileptic idiots; hypertrophy of the connecting tissue has been founcl
in them; to the same cause may probably be attributed convulsions
and sudden death in apparently healthy children, cases of which are in
the registers referred to in the Marylebone Infirmary. Of the 2,050
 ·August 28, 187 5.J THE BRITISH MEDICAL JOURNAL.
cases, 616 males and 653 females \Vere sane, and 430 males and 351
females insane. From the comparative table of the effects of ,·arious
diseases on the weight of the brain, in the sane and the insane of both
sexes, it appeared that, taking the total numbers, the cncephalon was
heaviest in the insane, the clifference being in the males three-fourths
of an ounce, and in the females an ounce ancl a q uarler. The average
weighb were as follows, taken from the whole of the cases:
Sane. Insane.
111. F. !\!. F.
Cerebrum 41.4 36.4 41.8 37.5
Cerebellum 5.1 4.6 5·4 4· 7
l'ons ancl medulla 1.0 1.0 0.9 1.0
Enccphalon . 47.5 41.9 48.2 43.2
Tables were then gi1·e11, showing the average weights in diseases of the
nervous system, pulmonary diseases, cardiac diseases and dropsy, ab-
dominal diseases, am\ typhus. Diseases of the nervous system were
most numerous amo11gst the insane males, amounting to nearly 47 per
cent. of their \\·hole number; this excess was due to the frequency
of general paralysis, a disease, as the symptoms indicate, usually
accompanied by softening and sometimes by induration of the spinal
cord as statccl by Dr. Doyel in 1848, confirmed by the microscopical
observations of !II r. Culli 1·er, and since by other observers. The
encephnlon was z;.; ounces below the average weight. In pulmonary
disease:-;, the cnccpha1on ''°as below the average weight in inales and
insane females. In cardiac cliseases, the encephahm was considerably
above the average weight in all classes, also in nlxlominal diseases,
except in :-auc males, in who1n it was the average weight. In fevers,
too, the enccphalon was above the average weight, ;;a that cerebral
wasting seems to accompany chronic diseases, cerebral and pulmonary.
Th,: l'.r1d1olo,;y 1f 1l/11sd,;. Ry J. S. N'AIR:\E, L.F.P.S., Glasgow.
-According to the author of this paper, man has a l"ychologic and a
pneumatologic nature. The latter is hichlen. Muscle is entirely re-
sponsible for the former; and the identity of the nel'\'e-centres with
n1usclc, /,,.,, as 1nusck i.') a~serted. The p~ychologic phcnmncna are
vital arnl intellectrwl ; the pO\\'Crs arc sensory and motor; and con-
sciousness is an attribute of muscle, but not necessarily of it alone.
This consciousness is progressiYe with organ, and at last amounts to
knowledge. The senses are the highest muscular organs of know-
ledge, and beyond them nncl without them there is no remembering
perceptive power. The being, the phenomena, the powers, are in all
cases the result ar11l necessity of definite c'luili\Jrium; without which
e'luililirium there is nothing.
.F'riila)', ~411gust Gth.
Th,• llj'f1>1l'l'!11i< hijcdic>/l 1f ,llc>rfhia i1t h1sa11i(1'. By J.
l\IcDL\R~lJJJ, l\I.B., l\lurthly.-After rnrne preliminary remarks, the
author spoke of the superiority of the hypodermic to the stomachic ad-
ministration of morphia. The physiological reasons were the greater
exactness of the dose, the easy administration in rebellious patients,
and the unanimous consent of experimenters. The usefulness of hypo-
dermic injection of morphia in insanity \\'as commented on, and its use
in inelancholia, acute mania, recurrent in::mia, chronic nulnia, and general
paralysis was illustrate<\ by cases. The habits of filthy elements were
improved uncler the hypodermic treatment. There was delayed action in
some patient>. Constipation \\·as not cnusc1l by this method of giving
morphia. Vomiting after subcutaneous injection was ·not frequent.
Hypodermic injection of morphia was unsuitable in maniacs suffer-
ing from heart-disease, and was to be employc1l only as a dcrnier
nssod. The use of atrnpia in combination with morphia subcu-
taneously \\·as dcscrilied; and also the closes of morphia required in
the various furms or insanity. The results obtained by this method
were compared \\·ith those of cannabis Indica, chloral, bromide of
potassium, and opium and morphia by the mouth.--Dr. CLOt:STO:\
(Edinburgh) said the effects of morphia in cases of insanity might be
dividecl into three classes: first, what might be called its specific effect on
melancholia; secondly, its ciuieting effect in cases of mania; and thirdly,
its sleep-producing effect in nil cases. In reganl to the first of these-
the specific action of morphia in melancholia-he performed a number
of experiments some years ago, treating the patients with morphia, and
administering doses of from half a grain to two grains. During the
progress of his experiments, he hacl weighed the patients every week,
hacl taken the temperature of their bodies, and ha<l their diet carefully
attended to. I le did not administer the morphia hyprnl~rmical!y; but
he supposed that, so far as its special effect on melancholia was con-
cerned, that 11;b of little account. The result of his obserrntions was
not in accordance with those of Dr. C\!cDinnnicl. Of twenty-two
patient,; with whom he had experimented, the great majority lost
weight during the treatment, while the appetite at the same time seemed
to diminish. In only three of the cases was there anything like that
effect following the close which had been so much lauded by various
writers. Then, again, his experiments as to the quieting properties of
morphia in cases of mania were certainly neither more hopeful nor
more satisfactory than those connected with melancholia. In nearly
every case, incleed, he found that the dose look away the appetite of
the patient; ancl for this reason he did not consider morphia so bene-
ficial as bromide of potassium and other remedies. In regard to the
mere sleep-producing effect of the morphia, he thought the chief obje~­
tions to it were the dryness of the mouth that was apt to be expen-
enced in the morning, and the excitement occasionally brought on
instead of sleep. On the whole, the results of his experiments in rela-
tion to the action of morphia on insane patients were such that he had
almost universally discontinued its use.-Dr. McDIAR,IID pointed out
that the results spoken of by Dr. Clouston might be attributed to the
fact, that that gentleman had administered about three times as much
morphia as had been done in the experiments which he had conducted.
Expcri111mts 011 the Brain of fl£011ke)'S, <i>ith <'Sfc·cia! Reference to !lie
Localisation of .Si·11s01y Centres in the Coni·o!11tio11s. Dy DA \'ID FERRI~R,
l\I. D., London.-The experiments on which the following conclusions
are based were supplementary to those of the electrical irritation of the
brain of monkeys, already published in the J'roccdin,~s of the Royal So-
ciety. They were recorded in detail in the Crooninn Lecture read
before the J{oyal Society in May last. In the absence of Dr. Ferrier,
Dr. Lnucler Brunton gave a brief summary of the main results. The
method followecl was the comparison of the effects of electrical irri-
tation with those following localised destruction of parts of the brain
by means of the actual cautery or scalpel. The two sets of experiments
supported and explained each other. The most important fact demon-
strated by this series of experiments was the localisation of regions of
special sense in the convolutions; and this, along \\·ith localisation of
centres of motion proper, served to clear up the true significance of the
reactions to electrical stimulation. I. Destruction of the frontal re-
gions of the brain, which giyes no reaction to electrical stimulation, is
\\·ithout effect on sensation or voluntary motion, but c~uses marked im-
pairment of intelligence and of the faculty of attention. 2. Destruction
of the grey matter of the convolutions bounding the fissure of Rolando
causes paralysis of voluntary motion on the opposite side of the body,
sensation remaining unaffected; while lesions circumscribed to areas,
previously localised by the author, caused paralysis of voluntary
motion limited to the muscular action excited hy electrical stimulation
of the same regions. 3. Destruction of the angular gyrus causes
blindness of the opposite eye, the other senses and voluntary motion
being unaffected. This blindness is only of temporary duration, pro-
vided the angular gyrus of the opposite hemisphere remains intact.
\Yhen both arc destroyed, the loss of visual perception is total and per-
manent. 4. Destruction of the superior temporo-sphenoiclal convolu-
tions abolishes conscious reaction to auditory stimuli, the other senses
and yo\untary motion remaining unaffected. The results of destruc-
tion, taken with the effects of electrical stimulation of this region, indi-
cate that it is the centre of auditory perception. 5. Destruction of the
hippocampus major and hippocampal convolution abolishes the sense
of touch on the opposite side of the body. 6. ] lestruction of the
subicu/11111 con111 a111J11011is, taken with the results of electrical stimuln·
tion, indicates that this is the seat of the sense of smell for the same side
of the body. 7. Destruction of the grey matter of the lower part of
the temporo-sphenoidal lobe in immediate relation to the region of
olfactory perception abolishes the sense of taste. 8. ] Jest ruction of the
optic thalamus causes complete an<esthesia of the opposite side of the
body. l). Ablation of the occipital lobes produces no effect on the
special senses or on the powers of voluntary motion, hut is followed by
a state of depression, with refusal of food, not to be accounted for by
mere constitutional disturbance. In one case, which survived the
operation for three weeks and was then killed, the appetite returned: a
phenomenon probably to be accounted for by compensatory associa-
tion. The sexual appetite, ho11·ever, was exhibitc1\ during the first
few clays after the operation, as judged by the behaviour of the animal
to a companion monkey. 10. Ablation both of frontal and occipital
lobes in one monkey did not interfere with the powers of sensation or
of voluntary motion.-Dr. ROBERTSON (Glasgow) thought those ex-
periments, though doubtless very interesting, should not lead us too
hastily to conclusions, as Dr. Ferrier's obsen·ations were much clis-
putecl, and the monkey's brain was not the same as a man's.-Dr.
SAUNllllY rcfcrrecl to Veyssiere's experiments on the localisation of
common sensibility.-Dr. DUPUY (Paris) gave the results of his own
obsenations, which differed from those of Dr. Ferrier.~ -Dr. CATn:-:
(Liverpool} had repeated many of those experiments, alHl could confirm
Dr. Ferrier's statements. He had only just been made aware that Dr.
Ferrier had been doing anything to localise special sense, and was very
pleased to find that the centre, assigned by Dr. Ferrier to the sense of
 THE BRITISH MEDICAL JOURNAL.
si_ght, was one which he had localised hy an entirely different method,
viz., that of noting the rnriations in the electrical currents of the brain
as caused by functional cxcrcisc.--Dr. FRASER and Dr. S)!ITII fol-
lowed_, and the latter e.,JH"CS>ecl the general sense of the meeting in
thankmg Dr. Lauder Brnnton for ably explaining Dr. Ferrier's Yie\\-s.
SECT!U'/ F.---PJIYSIOLOGY.
ll~·d1i,•sd11y, A11.~11st 4th.
DK. D1·Rnux S.\'/IJERS<J'I, F.R.S., !'resident, took the Chair al
I'.)[.
'J'ransfirence o_/ the fong J;•11don t~/ th(· Jiicl'fis 11fusr!e ji-olll li1t-' /-i°((l-
J,ula to the .!Iumer11s i11 Chnmit Disc<1s1' of the Shoulder. By JmrN
STRIJTHERS, M.D., Abcrclccn.-llr. Struthers explainecl how the
tendon, say in a rheumatic sl10uklcr, being no longer of any use, was
rcn:oved from the upper hone and joined on to the lower hone, hy
wluch its use was thereby to some extent preserved. The steps of this
pro~e~s. were narr:ited, an<! the subject was further elucicbted by the
exh_1b1t1on ?f spec1111e1E. Arlhering to the lower bone by the effects of
exc1tc;d action, the part of the tendon \Yithin the joint, having become
functionless, was seen in Yarious stages of passing away, while the
attachment of the lo\Yer bones, on which the muscle pulled, liecame
gradually stronger till the adaptation was completed. Dr. Struthers
rcn~arked that this mi,;ht be called a pathological process; but patho-
log1c~l processes "·ere abo physiological processes; and, he expected
that 1.n future, the qucly of these processes would thro"· much light on
quest10ns connected with the origin am! adaptation of healthy struc-
tures.
. Ex}'_eri111rnts on Cha11,,·e of the Rodi!y Tem}'rrature co1Zs1•q11mt 011 S·,·-
twn oj the Cord in the Ctn•iml Ri;~ion. Dy J. BURDON SANDERSOX,
M.D., LL.D., F.R.S., London.
. The Electric Currmts 1>/ the Brain. By RICHARD CATOX, ;\L D.,
L1verpool.-After a brief r/su111J of previous investigations, the author
gave an account of his own experiments on the brains of the rabbit
and the monkey. The follo,,-ing is a brief summary of the principal
results. In every brain hitherto examined, the galvanometer has in-
dicated the existence of electric current>. The external surface of the
grey matter is usually positi,·e in rebtion to the surface of a section
thrm~gh 1t. Feeble currents of vorying direction pass through the
multiplier when the clcctrorlcs arc placed on two points of the external
surface, or one electrode on the grey m'1lter, anrl one on the surface
of the :skull. The electric currents of the grey matter appear to h'1vc ,
a relation to its function. \\'hen any p'1rt of the grey matter is in
~state of _functional activity, its electric current usually exhibits ncg'1-
t1vc vanat10n. For example, on the areas shown by Dr. Ferrier to he
related to rotation of the head and to mastication, negative variation of
the current was obsen·erl to occur whenever those two acts respectively
were performed. Impressions through the senses were found to inOuence
the currents of certain areas; c..[[., the currents of that part of the
rabbit's brain which Dr. Ferrier has shown to be related to movements
of the eyelids, \Yerc foun<l to be m:irkeclly influenced by stimulation of
the opposite retina by light.
The D<~estiz•,; Pri111"ij!c o/.lnsNtiz·,,ro11s .!'!ants. By LAw,;o:-; TAIT,
F.R.C.S.Ed., Dirmingham.-:\!r. Tait communicated the results of cer-
tain experiments he had made, for the purpose of separating the diges-
tive principle or ferment, on ''"hich the remarkable po\\·er possessed by
certain plants, as pointccl out in Mr. lJarwin's recent interbting \\·ork,
is dependent. Mr. Tait showe<l that it was possible to separate this
principle from the plant for experimental purposes. As to the precise
method of its action, he was still engage< I in inquiry; but, so far as his
researches had gone, he was able to confirm the view taken hy Darwin,
that the chemical processes concerned in animal and plant digestion
were identical.
The E.ffeds of C!'r!ain /)nr~.,· 11}',>!l th,• .l11!racm11ial Cirrn!at/011, By J.
M. FoTI-IERGILL, M.IJ., J.ondon.-llr. Fothergill stated that, in pro-
ducing effects upon the intracranial vascularity, there were two factors:
( 1) a direct effect upon the circulatory system; and (2) an effect upon
the cerebral cells by which they attracted more blood, or less blood to
themseh·es. These factors cxistecl in yarying proportions in different
drug::; and according- to the exigencies of each case, one or other agent
should be chosen, as opium in cases of insomnia from pain, chloral-
hyclrate rather \\·hen the sleeple>Sness takes its origin in a high hlood-
prcssure. \\'hether the agent administered depre'5es or stimulates the
nerve-centres, its action can u~ually be intensified by giving it ~dong
with drugs which act directly upon the circulation, as opium with anti-
mony, and quinine, which affects the encephalic blood-vessels; with
digitalis, which raises the blood-pressure gene!'ally.
On a Case of Death from Suffocation in a Diver, illustrating some
Effects of .lntreased Pressure on the Pul!llo11ary Circulatiolf. By R.
[August 28, 1875.
BE\"ERIDGE, J\L D., AberJeen.-The death of this man occurred
almost immediately after his first descent for the season. There was
no defect in the apparatus, and his companion who descended with him
was unaffectecl ; it coul<l not, therefore, be clue to deficient supply of
air. On a previous occasion, this man had, under similar circum-
stance<, nearly lost his life. It also was his first descent for the season.
It was usual for cli,·ers on descending for the first time to experience a
feeling of oppre.ssion and a sensation as if the head would burst. This,
a:-; a rnlc, passed Yery quickly away, arnl nothing fnrther was observed
2 in the way of discomfort till after leaving the \\·ater, when there was
very often a sensation of gidtlines:-;, so111etin1es an attack of sickness,
arnl in many cases a flow of blood from the nose ancl mouth. Most
men after a few trials became accustomccl to the "·ork and suffered no
inconvenience, Lut some did not do so, and always suffered in sotne
way on leaving the water. These symptoms were undoubtedly <Inc to
the varying pressure on the vessels on the lungs, and in the above case
had produced complete stoppag-e of the pulmonary circulation. This
view was confirmed by the Jost 111,11"!!-!ll examination. The heart was
large, pale, and flabby; its cavities were empty of blood; the lungs were
intensely gorged with dark fluid blood. The air-tubes, beginning at
the fauces, were much congested, dark purple in colour; and the smalle1
bronchi were partially filled with dark frothy blood. Other organs
were also loaded with dark blood. The heavy pressure (in this case
doulJlecl) would cau-;;e partial stoppage of the lung-circulation, throwing
hack the Yenous blood on the right side of the heart, and thus inducing
insensibility and suffocation, while the <)Uick taking off of the pressur~
coulrl allow all those vessels to fill to the utmost, thus producing the
gre'1t gorging of all the bronchial surface, and the complete emptying
of the cavities of the hcart.--In the discussion that ensued, several
gentlemen expressed doulits as to the cause of the man's death, sug-
gesting that, although one of the diving-bells was safe, the other might
not have been so, and that this might not have been ascertained on
account of the connecting-tube being out of order.
7'/u1rst!lf)', A11_~1 list 5t.'1.
J'hysiolo,;>ic11! At'olfstits. By J. c;.. l\IcKE:\'DRICK, !II. D., Edinburgh.
-Dr. :\IcKendrick gave a demomtration on physiological acot1'tics,
with the view of illustrating the results of the researches of Helmholtz
reg:uding the quality of musical sounds. After pointing out that
llelmholtz had discovered th'1t a musical note consisted, not of one
tone, but of a series of tcmes, llr. :\[ cKendrick proceeded to show this
by means of an ingenious contrivance devised by Dr. Koenig of Paris.
]n a series of interesting- experiments, it was shown how a tone could
be decomposed, as it were, into its fundamental harmonies, and in this
way an actual flame-picture of it be obtained.
Effect of Dfrision of tl1t ,))'111}'athdic A'crve of the ,Veck in You11.~ A 11i,
ma!s. By \VILLIA\! STIR LI Nr;, D. Sc., M. D., Edinburgh.--Dr. ~tirling
saicl that the division of the sympathetic nerve in the neck, for instance,
of a young rabbit or clog was, in the first place, followed by the onlinary
symptoms of the operation. As the animal grew, however, it was
found that the ear of the side in which the nerve was divided grew
more than that on the other side. The hair of the ear upon this side
became stronger than on the opposite side; and, lastly, the tempera-
ture of the affected part continued higher than that of the other sicle for
several months together.
Anatvmy and Physio!o,;')' of th.: Semiciro1!11r C111111!s. By i\. CR\.'\!-
BRu\Y'I, ;\f.D., Eclinhurgli.·--The main object of the paper was to
elucidate the theory that these canals may afford our sense of equi-
librium and rotation. After stating the convictio11 that we possess a
sense of rotation quite distinct from all our other senses, Dr. Crum-
Brown proceeded to show that this sense must necessarily have a
special p~ripheral organ physically constituted so as to be affected by
rotation. The structure of the semicircular canals of the internal ear
\\·as, he c~nsiderecl, such as to fit them to act as such a peripheral
organ; and this vic\V was supported by the experiments of Flourens
and Goltz. The bony canals in question being filled with lic1uicl, rota-
tion of the head about an axis at right angles to the plane of a canal
would produce motion of the contents, and this might be expected to
irritate the terminations of the nen·es in the ampulla.
On .lnjection of the A-1i!nq in Bright's Disease, in Rdat/1111 to A!bt1-
111it111ria a11d .f£,r;1zaturia. By J. COATS, :\L ll., GlasgmY.
.·1 ..1-Vt'zi:.1 Ilisto/{Jgical J>rO(t'SS /(!r Stai11i11g Tissues. Hy }'RAXCES
Er.1Z.\BETII HoGGAX, !\!.D., London.-1\Irs. Hoggan said that the
process in question reconunendccl i~self principally on account of the
property it possessed of staining the substance of the cell as well as the
nucleus and nucleolus, and because it gave the best results where car-
minate of ammonia failed. It consisted in first pouring over the
specimen (after treating it with water and with methylated spirit) a
one-per-cent. solution of perchloride of iron; and, in a few minutes
· August 28, 1875.l THE BRITISH MEDICAL 'JOURNAL.
afterwards, a few drops of a two·per-cent. solution of pyrogallic acid--
both solutions being made in distilled water. A practical demonstra-
tion of the process was given by Mrs. Hoggan.
The Action of Stim11!a11ts and A~n·cotics. By TI!O~!AS P. IXCAS,
L. R. C. P. Ed., London.-This paper opened with a notice of ncrvc-
force. The author expressed the opinion that vitality is dependent upon
an exhibition of this force. He adduced several proofs to show that
it is most closely allied to electricity, and designated it as nervo-elec-
tricity. He diYided this nerrn-electricity into three parts: (I) that with
which the nerve.fibres, muscles, and tissues generally are always
charged, and which is spent in the rigor mortis-the residual; (2) the
radiant ncrvo-electricity, or that which is continuously pas-ing from the
body with the eliminatctl heat-the complementary; (3) that which is
called forth and dischargccl in 1he exhibition of eYeryvital pher10rrenon-
the supplementary neryo.electricity. The second portion of the paper
was devoted to a notice of the action of drugs on the ccrebro spinal
and sympathetic nerYes, in order to show that stimulants act through
the former, ancl narcotics by means of the latter. A number of proofs
were adduced to show the action of narcotics upon the sympathetic.
Instances were given to lJro\·c th~t ,timulation (narcotisation) of the sym-
pathetic induce,; general rebxation, contraction of the blood-\'essels,
and congestion of the capillaries, and consequent coma and death. On
the other hand, seYere stimulation (narcotisation) p:cralyses the f.ympa-
thetic; the resuit of which is that the cerehro·spinal exercise their
powers unchecked, anti more or less prolonged rigirlity of the muscles
ensues. ;\gain, tho~e 1ncclicines which stin1ulate the cerebra-spinal
(stimulants), cause increased acti\'ity in the parts stimulated; but if
pushed to a great degree, they exhaust, arnl, by a provision of nature,
nareotisation sets in ; if the stimulation be still further pushed, exhaus-
tion of the vital organs takes place, and death is instantaneous. In
conclusion, the paper went to show that, hy watching the action of
drugs upon animals, by pushing the trial to the extreme limits, and by
noting the post mortem appearances, we could ascertain the nerves on
which such drngs act. Thus, in disease, we should be able to apply
remedies in a scientific manner, not by an imaginary law of similia
rimilibus cura11t11r, but by a demonstrated law, contraria contrariis
1ura11t11r.
h·iday, August 6th.
The Inheritance of J\'<rvous Lesions. By EuGENE DUl'liY, M.D.,
Paris.
Capillaries iJt the U111bi!iml Cord. By LAWSON TAIT, F.R.C.S.,
Birmingham.
Demonstration of the illdhod of Ud11g the fl/·,·ezing· Almoto111e. By
W. RUTHERFORD, l\I.D., F.R.S., Edinburgh.
The lllagnetic Conditions of Arterial and Vmous Blood comiclered in
relatio1t to the injluence that Arterial Blood e_r,•rts in prom ofin,;; the
Functions of Life; and the ccmsequmt Value of Alagnctism as a Thera-
peutic Agent. By R. C. SHETTLE, i\LD., Reading.-In this paper,
the author referred to the experiments he had brought before the Royal
Society, in which he had demonstrated the fact that a grand distinction
exists in the physical properties of arterial and venous blood with
regard to magnetism, and that the magnetic properties of arterial
blood are dependent upon the oxygen absorbed in the blood, with the
amount of which they are in direct proportion. He next went on to
show that, as chemical action and electric action are in direct pro-
portion to each other, and the direction of the electric current is in the
same direction as chemical action, and as by another law the amount
of electric force generated is in direct relation with the amount of
magnetic disturbance, it follows thct, if the arterial blood is able to
sustain life by virtue of the chemical action of oxygen, it is equally
able to perform the same work by virtue of the magnetic disturbance
to which the motion of the corpuscles gives rise; and, inasmuch as
magnetic influences are exerted at sensible distances, and chemical
action depends upon the contact of bodies, it also followed that in
these operations of life chemical action must be secondary to and
directed by magnetic action. IIe next pointed out that it is to the
influence of the magnetism of the earth acting upon the molecules of
matter in the circulating fluid in certain conditions that the corpuscles
and various other organic principles owe their existence, and that the
different characters which the blood.corpuscles assume in the four
great divisions of the animal kingdom result : I. From the food upon
which the animal lives; and 2. From its habits of life; and, inasmuch
as they i·esult from the mode in which matter acts upon force and force
upon matter, they naturally acquire properties peculiar to the animal
in which they have been formed, and these peculiarities they again
impart to successive generations of corpuscles. And, in accordance
with this law, they would be liable to certain modifications by a
279
change in the habits or food of the animal in which they existed.
The proper selection of food becomes, therefore, a matter of great
importance with regard to health, every form of matter taken into
the system having its own specific magnetic influence : I. Over the
blood-corpuscles ; and 2. Through them over the nerve-currents; dis-
order or disease resulting from the imperfect manner in which organic
principles are formecl and combined either from insufficiency of force
or impurity of matter acted upon. \Vith regard to the treatment of
disease by medicines, he showed by the above law that, as a rule, all
drugs act by virtue of the magnetic characters they impart to the blood.
Iron, one of our best and most universal tonics, strengthens the system
by adding to the magnetic character of the blood, so inducing more
powerful currents of electricity in the nerves. Magnetic bands applied
externally are frequently of the greatest service, either alone or in
conjunction with internal remedies, a> they increase the polar influ-
ence of the part over which they are placed. The author con-
cluded his paper by pointing out that the doctrine hitherto held
has been that oxygen supports animal life by its chemical pro-
perties under the influence of a mysterious vital force (the laws of
which must necessarily be as unknown as they are mysterious). \Vith
reference to the theological bearing of the subject, he showed that
the fact of vital activity being referred to m:tgnetic action only testified
to the simplicity and unity of purpose which pcrvacles all the works of
the Creator, the grandeur of which becomes apparent not only in the
phenomena of terrestrial magnetism, but also in the application of the
s:une force to all the phenomena of life.
Comparative l'harmaco!ogy. By JA~rns Ross, l\I. D., \Yaterfoot,
i\fanchester.
A llfeans of Preventing Death during the Extraction of Tedh und<"r
Chloroform. By T. LAliDER BRUXTON, i\I.D., F.R.S., London.
SELECTIONS FROM JOURNALS.
MIDWIFERY AND DISEASJ;:S OF WOMEN.
THE UNMAXAGEABLE VoMITINGS OF PREGNANCY.-The :Journal
de il:f/decine et de Chirm;<[ie quotes a communication from M. Tarnier
respecting a case in which, in a multipara in the third month of preg-
nancy, serious unmanageable vomitings were arrested by the simple
application of a plug of wadding to the vagina. He collates with this
fact three cases published in the BRITISH MEDICAL JOURNAL, in
which Dr. E. Copeman saw very serious vomitings arrested by the
dilatation of the neck of the uterus. In the first case, the digital
dilatation of the neck was to have been followed by puncture of the
membranes to induce abortion at six months. A fortunate delay de-
monstrated to Dr. Copeman that dilatation had a great influence on the
arrest of the vomitings. Pregnancy went on in due course, and the
patient was deli\'ered at the proper time. In a second case, the result
was intentionally sought and obtained in the second month of preg-
nancy. In a third, pregnancy had reached the eighth month. The
vomitings were also stopped, and the patient was delivered eighteen
days afterwards, when she had already regained some strength. The
plug and the dilatation of the neck are two mechanical methods which,
in the opinion of the writer who comments on these cases in the I.1•011
Jl.lMical, are very rational, though undoubtedly acting by a different
mechanism. The plug prevents the shaking about of the womb; the
dilatation of the neck detaches the membranes over a certain space,
and prevents the twitchings or distension of the internal orifice.
PATHOLOGY.
i\[ALFOR~!ATI0:-1 OF Anno~IINAL OR<:ANs.-R. \Viinsche describes,
in the eighth volume of the :Jahrbuch fi!r Ki11daheilk11nde, new series, a
case of congenital occlusion of the pylorus, with occlusion of the duo-
denum at its passage into the jejunum, absence of the gall-bladder,
and atresia of the sigmoid flexure. The duodenum was dilated into a
large sac, almost twice the size of the stomach, which was normal; it
contained a quantity of thin brownish-yellow fluid. The jejunum and
ileum were of the calibre of a quill, and quite empty ; the large in-
testine was not much stronger, and contained a little mucus. From
the liver, which was of normal texture, a. rather wide hepatic duct
passed into the duodenum; the ducts of \Virsung and Santorini were
also abnormally dilated. The child in which these malformations oc-
curred died six days after birth. Two other children of the same
parents had, it was said, previously died at the same age.-Cmtralblatt
fiir die Medicin. Wissmsch., May 18th, 1875. ·