August 28, i875.] THE BRITISH MEDICAL
257
FORTY-THIRD ANNUAL MEETING
OF THE
BRITISH MEDICAL ASSOCIATION.
Heed in EDIXBtVII G1I, August 3rd, 4/hz, 5/h, and 6/li, I875.
PROCEEDINGS OF SECTIONS.
SUBJOINED are abstracts of most of the papers presentecl to the several
Sections of the Association at the Annual Meeting. The papers
themselves, as opportunities occur, will be publislhed in full in the
JOURNAL.
SECTION B. SURGERY.
Vednesdaye, Au,gutst 4t/h.
TiIE Chair was taken by tile President, JOSEpII LISTER, Esq., F.R. S.
Demzons/roitn lt h Ti-eal/meut of C/tul'-Ioo/. By W. J. Li IILE,
on
M.D., London.-Dr. Little first alluded to Stromeycr's great discove-y
of subcutaneous tenotomy, published in I831. In i536, he himiiself,
by the study of specimiiens in the museums at Berlin, came to the Con-
clusion that contraction of the tendo Achillis w-as not the onily cause
of distortion; but that the anterior and posterior tibials xv ere also
effective. Accordingly he bad, as early as 1837, divided the tendons
of these muscles in cases where it seemed necessary. After slhowing
how the average age at which patients w-ere operated on had gradually
decreased from eighteen years to a few w'eeks or even days, Dr. Little
went on to consider tIle causes of imperfect cures or relapses of the
deformity after an alpparent cure. These he considered to be the fol-
lowing. i. Onissioli of operation at an early period. Tile earlier the
period of operation, the iwore perfect would be the cure. Operation
might be practised the day after birth. 2. The undue importance
attached to the div isioni of the tendo Achillis alone. 3. The treatmeilt
by instruments wihere the patient's foot as kept too long in a fixed po-
w pressure was a made, a stream of similar character could be felt passing
sition. By this, the healthy use of the joint was lost. 4. The en-
trusting of the after-treatment too muchi 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 Iiis reapplying tile apparatus. 5. The ilnsuf-
ficient estimate of the difficulties sometimes met with by tile operator,
aild his consequent neglect to inform the parents of the true nature of the
case. lIe wNas in the hiabit of informing pareilts that the after-treat-
ment of the case w,vould be required to be attenlded to by them uIltil
their cliild had arrived at an age when it wvas responsible for itself.
6. Improper use of apparatus in those cases wihere the cure liad niot
been completed before the patient w'as able to wallk. In relapsed cases,
lie deprecated redivision of the tendon, or resection of the muscle itself.
The heroic psoposal to divide all the tissues eni moiasse betw-eeni the skin
and tarsal arch was uuiiieccssary and useless. Even althoulah there was
no risk of bleeding, andcl though the divided nerves united again, still
there wvould probably be pain and risk. Ile had endeavoureci from
an early period to simplify the mechanical appliances emnployed,
whether or not any cutting operation in each particular case be ilee(led.
During the last teil years, he hlad gradually advaslced to the present
state of Iiis experience that every case of congenital varus in anl infailt
under nine or ten moilths of age requires absolutely no otller me-
chanical appliances than a roller bandage anid one or mor-e 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 Stronmeyer's modified Scarpa's shoe, or upon steel and
India-rusbber springs, ith leg-irons, is only required wheis eitlier ill-
fortune, inattentioll, or neglect has prevented the trenitmenlt fi-om leing
carried out early or ill a thoroughl manner. He laid dow-n the follow-
ing rules. Whetller or not anly division of tendoris be deemed neces-
sary, commence the treatment at the earliest period the healtis of the
infant, the state of the mother, and other circumstances, permit, even
within twenty-four lioirs or the first w!eek of birth. If in doubt as
to need of operation, " take farther advice", or try gentle iiechailical
treatment onily, by means of his splints, for a fev eeks. Wlhetller or
w beinig fatal. He recommended attenition to the following particulars.
not any operation be performedl, remove and reapply the splint at
least once ill eacli twenty-four hours, aild whene-er it appears to be
seriously displaced. Practise and teach the nurse to effect, daily
or oftener, gentle manipulations, pressings and stretchiisgs of the
distorte(I parts tow'ar(ds the desired form and position, aidle guard
against the ankle losinig anly portion of its natural lm6vement ; over-
come thoroughly the inversion of the foot and the contraction of tile
sole before attempting to bring down the heel, especially if resort be
_70URNAL.
had to operation.
257~~~~~~
However favourably the case may progress, do not
permit the part to assume for a moment anly portion of the former evil
position, from wlhiclh the treatment may have gradually rescued it, or
allow the child on any pretence to be placed on the foot before full
natural eversion and bendingr can be readily effected by the attendant
and anatomically or spontanieously by the child. A well treated suc-
cessful case of severe congeniital varus can apply the sole and heel pro-
perly to the ground with the toes turned out, and walk at the ace
of t elve to sixteen months as well as a sound child. In conclusion, Dr.
Little showved how he considered a cure of club- foot could be effected be-
fore the child was twvelve months old, so that not only should the foot be
perfect in shape, but also in function. This conisistedI 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 virtus, assumed that of valoi's. It should
be kept at this for a few days. While this process was going on, the
movemiient of the foot at the ankle should be performedl each day. If
necessary, the tendo Achillis might be dividedl, and a splint with a
screwN, used. By this means, the sur(geon could, in twelve months, obtain
a perfect cure, and tlhus avoid all unnecessary expense to the parents,
or annoyance to the patienit. The author exhibite(d a series of his splints
for the cure of congenital club-foot in infants, and of other apparatus,
for inicompletely cured, relapsed, and neglected cases, employed from
the time of Scarpa to the present day.
Pi-esidleut's Adbdress-The PRESIDENT delivered an address.
zV OIL' on a Peculiarir Varieljy of Ifyedrocele of the Cod(. By FURNEA UX
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 ani impuluse- on coughing, at whlich time a fine
rustling stream of fluid could be felt passing through a second tube
from the abdomen to the enlargemenit. W hen firm and persistent
from the swelling to the abdomen. There ivas at no time any sign of
protruding bowel. 1Ir. Jordan believed that, in its anatomical cha-
racters, and in its mode of formation, the enilargement 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 recommende(d was a light truss, to cut off the communication with
the abdomen. -Mr. RIVING TON (London) took exception to the nomen-
clature of the case. It wras 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.-M\r. 0.
PE.MBERTON (Birmilnglhamn) thouglht it wvas simply a portion of peri-
tonieum containing peritoileal fluiid, to which the term hydrocele did
t apply. Puncture would have ledl to a communication w ith the
peritoneal sac.-The PRESIDENT thoulght that it might be diffused hv-
drocele of the cord where there xwas fluid in its cellular tissue, commul-
nicating vith the cellular tissue of the iliac fossa. It thus could be
indcluced with difficulty; and, wlhen the patient stood up, a rushing
sound was heard from the flLuid making its w%ay back. He thought
that it was a misnomer to call it congrenital hydrocele, as the tuDe
opened inlto the peritoneum.-Dr. PI1`RIE (Aber(leen) thought that the
case -svas analogous to one he had met with. In it, there was nothing
in the scrotum; buit two little tumours could be felt in the cord. They
didl niot communicate with one another ; nor di(d the upper one open
into the peritoneum. He therefore believed them to be two hydro-
celes of the cord, due to the irregular contraction of the tubular prolonga-
tions. He thus held that there was an accumulation of fluid before
closure. They differe(d from Mr. Jor-dan's case in having no commu-
nication with the peritoneum.-MIr. F. JORDAN was afrai(d he had been
less distinct in his paper than desirable. In the programme it was
(lescribecd as hvdrocele of the cord.-M1r. RIvINGTON objected to the
term "encysted".
Excision of/le Thyroid CloZud. By P. UHF-RON WVATSON, ML.D., Edin-
burgh. -Dr. Watsoni noticed the opinlions of sturgical authorities on the
subject, and described five cases in which he had operated, one of them
I. T he external incision should extend from the larynx to the sternum,
if the tumour be large and spread wA-idely in a lateral direction. 2. TIhe
vessels-arteries and veiins-shoul(d 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-
mastoid muscles. 4. The delicate investing fascial sheath of the thyroid
body should be left undivided unitil the vessels included in it have been
tied. 5. After the mediate ligature of the thyroidal vessels in the cel-
 2;8 THE BRITISH MEDICAL
lular sheath, the capsule of the thyroid gland should be opened by
stretching through it in the middle line, and the attachments of the
goitre carefully dlivided
by blunt-pointed scissors curved on the flat.
There should 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
tet m5asse along- writh the cellular sheath.-Mr. LENNOX BROWNE
(Londoni) felt that the operation for goitre was one of which
he couldl not approv e, simply because it was unnecessary. In
none of the cases (lid there seem to be dysphagia or difficulty in
breathing. The filst case was typical, viz., a young lady with a goltre
about the size of a China orange. When an incision was made from
the laryinx to the sternum, the cicatrix caused a worse deformity than
the goitre itself. lout
thei-e were other means of removiing the gland
e(qually cer-taini, and leaving nlo
mark. There were four varieties of
goitre, Niz., simple, fibtroid, cystic, anid fibro-cystic. In the simple,
counterirritation. by the red iodide of mercury was sufficient. In the
fibroid, inijection of iodinie inlto
the substance of the glanid produced
alostonderful results, without resulting deformity. In the cystic,
any
w
'e used to iniject io(linie. lIe however, tapped, injected with
now,
perchloride of ir-on, alnd plugged the cannula. In about forty or fifty
cases, there hadl been only one dleath. In the fibro-cystic form, setons
-were of great valne ; or Maisonneuve's darts of chloride of zinc might
be used. lie therefore believed that the operation was unnecessary -
and, althouglh it was brilliant enough, it was better to try milder
measures, remembering the aphorism of Ilippocrates, viz., "to cure
the patienit witlh as little harm as possible".-The PRESIDENT said
that lhe had onily seen Dr. Watson's unsuccessful case. The principle,
howvever, seemed a sound one. An improvement he had made was
to subdivi(de the part ligatured, and ligature each half. The larger the
tumour was, the grceater the risk. If it were large and overlapped the
carotid sheatlh,
it was importanit to tie the tissues with the vessels at such
distance that, w,vhen the fascial sheath was divided, there should be no
risk of hxl -orlhagc from the ligature slipping. He therefore passed an
aneurism-needle from the middle to the side, and divided the ligature.
He inext passed a nieedle 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
bleeding. In the first case, the gland enveloped the trachea, and
overlapped the carotid sheath. The second was extremely vascular,
was principally oni one side, and largely overlapped the carotid vessels.
One vein, dutring the operation, was so large as to look like the in-
ternal jugular. The operations were perfornmed antiseptically. There
was no sttppuration in one case, and only a little tension in the other.
llemp was used for the thyroid vessels, as the catgut was hardly strong
enoughi. Dr. Thomas Keith, however, had shown him some, kept for
five years, which wvas exceedingly strong, and, by twisting it in strands,
it could be used for anly
purpose. In both the cases operated on there
was severe (lyspnoea.-Dr. WATSON said that, perhaps, he did not go
into symptoms sufficiently, so to settle, to the satisfaction of some,
as
the propjuiety of operating. In all his cases, there were difficulty in
deglutitioin,stridor of br-eathing, and affection of the general health.
The operations were certainly not undertaken as a derntier ressort, 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 risk, not only of disfigurement, but of death. The dis-
figurement was large wlhen the incision was made; but, even after
twenty-foutr honirs, there was great contraction. In one case, an inci-
sion of inches contracted to an inch and a half. In regard to
seven
Maisonneuve'sAches, he had heard of a case where the incision for their
introductioln was followed by severe bleeding. This was arrested by
lint strips. After the separation of each slough, bleeding also took
place; so that the patien-t was in great danger, and ultimately re-
covered, svith 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 goltre, whether unilocular or multilocular,
he would not operate until he had tried tapping. In all his cases he
had done so. In his first, he had tapped and iniected* but other cysts
appeared. lie tlherefore deemed it inexpedient to wait and operate as
a skernzier ressort. Iln the cases operated on, both his colleagues and
hiimself were satisfied as to the necessity of operation.
A
Case in wdic/h Adams's Operationt for Sucbcutaneous Divisionl ofthe
MVc/k ofthse T/i&/s-bone was perfortmze(d ont Both Sidtes in the samze Patient
for Straivg/-t Anl/zyosis. By EDWARD LUND, F.R.C.S.Eng., Man-
chester.-In 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
_70URNAL. [August 28,I I875.,
,
of motion in both hips; he could support the weight of his bodv
on either leg; and he had greatly improved in all respects.-Mr.
WILLIA'm ADAMIS (London) felt sure that no one could congratulate Ir.
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 strumous child, with little ankylosis. As a rule, the
cases to be operated on were, beginning with the best, rheumatic,
pytemic, 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.
Tix'o Cases of Anemrism, o ze of the Carotist atd onze oj t/ze Femo;-aJf
Artey,tteaed by the WVir-e Comporess. ByJ. Dix, M.R.C.S.SEng., HUll.-
The -w,vire compress here spoken of was introduced to the profession by
Mr. Dix ten years agyo, as a substitute for the ligature. The full cle-
tails of the methocl, with illustrative cases, were published in the Eduss-
b,rg/s AZOfst/y _7ouz-nal for September I864. At that time, he hadl
only used it for wounded blood-vessels; but lie 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 dav 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 onl
the sixth and sevelnth days. 'This the author considered one of the
greatest advantages of his method, as it allows the gradual establislh-
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 hlemorrhage 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. ThLus 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 I854, he had used no other method of arresting hlemorrhage in
anly 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 t/Me oderws Treatmenzt of thze Advanced Stages ofCUonstitutional
Sjp/hilis. 13y WILLIANI ACTON, M.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, an(d 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
-i. That mercury is most successful in the treatment of secondary
symptoms; 2. That iodide of potassium is to be principally depenlded
on in tertiary symptoms; 3. That a mixed treatment is applicable in
cases of advanced constitutional syphilis. In conclusion,he made some
remarks on the necessity of preventing syphilis, and described the re-
sult of observations whichhe had made on prostitution in Ediiiburgh,
where he found the evil to prevail to an excessive extent.
Tracheotomy! in Crotsp and Diphtheria. By GEORGE BUCIHANAN,
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 tfacheotomy in croup and diphtheria 46, cured 17, died
29; croup i6 cases, cured 6, died IO; diphtheria 30 cases, cured ii,
diedI9.
 Auyust 28, I875.] THE BRITISII MEDICAL 70URNAL. 259

Thze Tr-eotzinent of Potentt Urachuts. By J. J. CHIARLES, M.D.,

Belfast. Tlnunsdoy,, Aug9ust 5th.-
Ctase of Pe;for-ationt of the Abdomuen per Vagninam; wvith Remnarks. On Ligatur-e of thie Commiont 1.mnoroal ArtIey;j and esp5ecially onl Lioa-
By ALF XAN)FR. E. MCeR si.E M.D.. 1Penicuick. ltine by ani Antiseptic Afater-ial. By OLIV'ER PEiMBERTON, F. R. C. S. Ed.,
A4 Case of Partiai'l Abejturie of the Popliteal Artlery, and Complete Birmingham.-Mr. Pemberton began by referring to a case dlescribed
Ruiplture of the I'Opliteal !VJn, ]or- which Prioizazy Azpuotoionte by him in his Address on Surgery at the meeting of the Association in
Thig,h was per-formel. lBy W. RivINGTON, F.R.C. SEng., London. I873, in which, as he then supposed, be tied the commoni femyoral
-The patienit wvas a h-ealthy young, man, agred i9, who w%as ridling artery for an aneurism in Scarpa's space. The operation was successful
on the fronit seat of an om-nibus, w hl-en a runaw,ay horse and cart dashied as regarded the main issue ; but, the patient having since died from
at the omnibuis, anid a cornier of the cover of the cart struck. him on the another cause, Mr. P'emberton had found that the circumflex i1ii, the
left knee, driving, it forcibly backwvards. On hiis admission into the epigastric, and thc piofuinda fcmoris aitcriies, wcice given off tougetlier
London lhospital soon after the accident, there wvas much contuision of above Poupart's ligament; and that he had tied the superficial femioral
the knee, but no sig,ns of fracture or dlislocation. The swelling of the artery. The portion of vessel (five-eighthis of an inch) between the
par-t increased, and the patient com-iplained of loss of sensation in the~ point of ligature and thae origin of the above-named branchesi was
leg; the temlperatnre of the lim-b also fell. Pnilsation couild be barely firmly plugged. He theni went oni to argue that it wias the surgeon's
felt in the posterior tibial aitery. On aniscultationi, a low clickinig duty in such cases to tie the common femoral artery in preference to
sound wvas hieard in the course of the popliteal ar-tery; and the dia- the common iliac; because it produced less danger to the patienlt, and
gnosis formed was probable ruipture of the artery. This diagnosis was because there wvas yet an artery left to tie in case of failure. Ile did
concuiried in the niext dlay, by Mr. Hlutch-iinson; anid amputation w,as not regard the risk of secondlary hc-emorrhage, insisted on by Mi.
perfolrmedl by a miodificationi of Teale's operationi. The patient ulti- Erichsen, an objection to the ligature of the common femoral; and hie
miately dlidI well. Oni examiniiationi, ther-e was found to be extenisive believed that this risk mighit he diiniiishied er even removed by the use
effutsion of blood in the aieolar tistie of the limb). The posterior liga- of an antiseptic catguit ligature, applied in suchi a way as to close the
ment of the knee-joint Nvas slightly torni ; aiml thle planltar-is mluesle artery withouit cuitting it thiroughi. He believed that tile objection as to
'was torni fi-omi its attachmecnt to tile feimur. The popliteal vein- w,as the point of origin of the proffunda was of nio real importance if the
completely secered ; and( tile inner and rniidl(le coats of the artery wvcrc vessel wvere niot cut through.-Mr. LU-ND (Manchester) wished to
separ ated fi-oim the extdr-ianl. The ligamyentous and( car til.iginouu stiuc- know when tile hlenpen ligature cam--e away, anid whether it was,
tllres fte on wsereinj:e rlte extei-i.I codl f h enu wan thoa, showogr that there bad beeni division of the artery. In
wv-,,I neairly separated 1I y a fissure, w bIile a small tri ang,ular i ieee (If the othcr case, dlid the ligature under-o solutioni, or remain as a
lonie lay loose and pireje_cted inito the joinit. Theli upper part of the fibrous band ? Mlr. PtEwiMiaRTo. saidl that the hempen ligature- came
tibia w,as also fissured. 1 'he hiistory of the case was followed byv some away thirty days after operation. As the loop) of whipcord wNas initact, it
practical comnments. myust undoubtedly hiave cut its wvay thiroughi the tissues of the vessel. -
Demnonstr-ation on.St/v of the Ur-eth; a. B3y F. N. 0 ris, MT.D., Mlr. Dix (H-ull) saidI that it was remaikable, hie thoughit, that tile
New York.-Dr. Otis said that a strictuire of the uirethria mighilt be ai-tery he m-entionied in hiis paper read on the previous (lay as not being
cauised by an-y inflamimationi w-iclie spread below tIle muLcouis membrane ligaturedl for fear of secondlary hzemorrhage, was the common femoral.
so as to cause a dleposit (If tkssue in the subiitiucoiis coat, and( conlse- TIhe point on which hie wishedl most particularly to dwell was the com-
quenit obstruction of thie calibre of the canal. This obstruction mighlt pacrison of the catgut ligature withi his own method by means of the
vary from a slight constriction to complete oblliterationi. B3y somle, it wire compress. The advantages of the catgut ligature wvere, hie
wsas cons idered thiat where a No. 8 or 9 instrument of the Eniglish scale thought: i, that it was not a foreign body; 2, that it did not dlamage
passcdl, there couldl lIe no stricture. This lie consicleredl entirely the internal coats; 3 that it did not require to be detached by ulcera-
wrongy. By means of hiis ur-ethrometer, he wvas enabled to ascertain tion as in the case of the silk ligature. It, however, might give way
the calibre of the uretlira. In a series of about five hiundred cases, hie too soon; and in one case the clot had been carried to the brain oni the
biad established the fact that theie was a conistant relation between the second day. But by his method the wire couldl not yield too soon, nor
circumference of the flaccidI orgTan andl that of the urethira itself. He become detached. Above all, the circulation was not cut off too
,%vent oni to show, how the slightest constriition of the ur-ethria p)roilucedl quickly. The circulation was at first feeble, allowing deposition of
fr-ictioni ; and( that thiis, leading to irritation, caused, w,hen it b~ecame lymph. Then, w,hen the wvire wvas tighitenied, the clot w,as compaletely conl-
chronic, gleet. Gleet hie considered as the indicationi of a stricture. solidated. The wvire could then be taken away wNithout fear of seconidaryy
'fhere nileht be, of course, strictuire without gleet. Ilis plani wvas to hri-emorrhage. Mlr. RIVINGTON (London) asked hiow Mir. Dix was sure
dilate tile urethira, after ascertainiiig its calibre andI the position of tIle that tIle wire dlidi not cuit thiroughi the vessel.-.Mr. Dix saidI that, in
stiicture. The dlilatation w%as to be carr-ied at least two dlegrees beyonid the case of carotidl anemrism, there was pulsation wh71en the wvire was r-e-
the ascertained norminl calibre of the canal. Bly means of a fine knife moved.--MNr. FURNEAUX JORDAN (Birminghiam) conigratulated M'r
tuvo minslimIt;v1's in b)readitlh, the stricture wNas then dlivi(ledl internally. 1Pemberton on- his paper. At St. Barthiolomew's hlospital, hie hadi seeni
By) this meanis, it couild also be asceertaineed accurately,%whether thlere wierec Sir James Paget apply a ligature to the com-mon femoral in a stump
iil(ore than onie strictuire, so that they coduldi be dlealt wvith. in the samec where there wvas bleclingc due to slougrhing.-Dr. PIRRIE (Abei-deen)
nlannier'. thioughlt tllat their present experience dldd n-ot warrant them in g,iving a
J)emonsc/ratio)? if_ Co/,I/i/ch'alvid frnsplantotion frinz thie Rabbit to the diefinite opinion on the merits of acupressure and the catgut ligature.
Ilnmnzn SnIt By J. R. Wos Fi E,MA . D., Glaisg(owN. -I) r. W olIfe fi rs t Everyone knewv that from-i limitedI statistics any conclusions could be
(lesci-ibed the ilature of the affectioin in w hlichi this transplantation was dIrawn. It wNas their plresenit eduty to collect facts. There was a
necessaiy; viz., in adhesions between the apposedI surfaces of thec con- remarkable unaniumity am-ongc the members of the profession in regardl
dIntva(le toinjury. Pi-evions attempts toremeely this hiad been toligature of th-e cniio femnorda beino unidesrbel,hl hto h
mechanical, and therefOre useless. In 1572, hie dieviscdl this methodl of exterlnal iliac w,Aas IiigIlly successfuil. MIr. LIsTERi (Edinburghi) dli(I dlot
transplantation ; and( it wias niowi practised by Becker, V-on CGraefe, and suppose that Mfr. Pemblerton mieant that a hempen ligature would be
othemrs. DJetails as to how it wvas dloi'e were, thlerefore, nie(eded. T wo without risk wvhen applied oni an arterial trunke near a large branchi.
patients wlioin hie had undi(er tr-eatm--ent were shown. i. F. B., agedi 9, The origin of the branches of the commion f-moral variedl extr-emlely;
hadl his righit eye bum ned w ith limie in Januar-y las,t, the cornea, being aiidl it mi-ade all the ilifferenice, wh-lethier the ligatuire wvas applied clos:e
r-endleredI almost ei-tir-ely dl aque, wiithi the exception dof thle smlall upper Ito a lar-ge branch or a quar-ter of ani inich above itL. As to the catguti
anelI outer segmlent. th'ie iupdl wsas tlluis coimpletely covered wvith tile ligature niot CuIttimlg thlrough1 the interinal aid nii-ledle coats, lie alwa) s
a(Iierent lower eveliil. D r. Wdolfe first turniedI t'ile trainsparcint pe tioni apsplieed it so as to d1,o so. At his anltiseptic elemonistr-ation, lie hact
of tile coi-itea to accouiiLt Ily imakilg ani aitificial Ppup1 upiwardls all ont- pointedl out 110wA thle ligatuii e was not pro-peily prepared, as his owni
w%-arels. Eight elays ago, lie operated for the cui-e of the syimlllephlaroin. dhirectioins were wvrong,. Ilie had prepacii it iightly hiimself; but it wvas
Somle of tle ligatnires w\vere still imn tIle nlew coinjunctiva fr-om tile rabbit, by accidlent. TIle catg,ut ligatumre, wshIen riailitly prepared, could be
2. Peter C.-, ageel 20, a cinairiymnii, w\as op-erated oil oil Jainuiry 23rd, useel witllout risk. 1lIcialad tlicl tIle feiilioral airtery four- tiilles, ailel the
573. hIlle ltiil hd li facenoel 11011 eves injured fromi a gun- car-otid OIICe Withl SItseCCe. folly; and Iiis colleague Mr-. Ailiiaidlale
powdeer explosioil. I fus left eye wvas coilpletely blinileled ly a symnidle- had liadi the sam-e explereilene with regard to tile fenmoral, tlie caiotidl,
piharoin. I)r. NVolfe ilidle nil iridlectomy dipwaids, and tlleil rem-eeliedl aile tile exteriial iliac. In nione of tilese cases hade thiere beein amny
syibllepliaroi. foli te tile treatmleilt
le preseilteel hiioself again for,onjninctiva
tile of' tile rabbit. A foitnight -too -ivi va.Ar.
of Iiis evertedI eyelmel of tile there was nil albidingPEMsitu
coagulum;
in reply1, said tilat lin his fir-st case
aRTON, aindl i~i the seconeld, wiere lhe luted tied
righlt eye, Ilenil I)r. Wolfe fouild tllat a small bridge liadI form-el inl tIle tIle artery one inch below Poupart's ligamen't, theme was no severance of
new conjunctiva, wIrliiclilihe seplarated, and supplicel a niew conjunctival the tube of the artery. Ligature of tIle exterinal iliac wvas successful;
flap. but Mlr. Lister should niot forget cases whiere the aneurism recurred. It
 260
4 kj%j THE BRITISH MEDICAL
--- 70URNAL. [AugUSt 28, i875.
certainly was not gnood to have recurrence, or to tie the artery ag,ain that of securing sufficient prominence to the new substitute. It was
above the form-ecr ligTatuLre. evident that if the latter consisted of soft parts alone, it would in a
0' c-i , Jo t.ie Obliteration ofOD :pr'isscd Cical/rices of /er- short time become nothing more than a mere covering over the cavity
Glen'lnar- -IIlsct'ses f Rotwe. By WILLIAM ADAMS, it wvas tlherefore necessary to provide a bony support for the superstruc-
ture of soft parts. It was thought that this endI might have been at-
or- . lie/io

F1..C. S Eg.., London.-TIe operation- consists of the following steps:

I. Subcutaneously dixitdig(T all the deep adhesions of the cicatrix by a tained by partially detaching the nasal process of each superior maxilla,
teniotoimy-lknife introduced a little beyonid the margini of the cicatrix, and connecting them in the middle line. Oin fuirther reflection,a how-
an(l carnied1 (doNN-ii to its base: 2. Carefuilly and thoroiglhly evertinig ever, this method was discarded,
cientlyand
appearedl
as it unlikely that suffi-
lon(g piece of bone could be obtained to serve inistead of both
time depres.sedl cicatriix, turningr it, as it were, inside out, so that the
cicatricial tissue remnainis promiiinently raised: 3. Passing two ohare-lip bolnes cartilages. It wvas then determined to
a portion of one of the patient's fingers for the end in view.
enldeavour to utilise
Accord-
pins or fiieir iieedles throungli the base, atandright angles to each other, so
suirface
to miiaiiitaiii the cicati-ix in its everted raised form for tlree days ingly,lastani incisionofwasthemade along the middlea of the palmar of
inicision at its
as

4. Remnoving the niee(les oni Llhe third(lday, an(d allowing the cicatricial thle phalanx wTith
left forefinger, transver.se
base. Two flaps of skin were theni raised, onie at eachside of the fiuger.
tissue, n1owr somewx hat swollen, succulenit, and infiltrated, gradually to
fall diownN- to the propcr level of the surrounding skini. Three cases, in These were then stitched to the previously dlenude(l margins of the
which this ope ation had been performed by Mr. Adams, at periods cavity, and the arm was carefully supported by means of long sti-ips of
vairying from eleveni, ninle, an(d three years from the present date adhesive plaster passed round the neck and under the elbow. Union
ere adduce(d in illusti-ation. In the last two cases described, took place oni one side by adhesion, on the other by graniulation.
arm was retained in its position for the period of three months, in or(ler
Tlhe
one resulting fr-om glandlular abscesses in the neck, and( the other
from niecrosis of the inferior maxillary bone, all traces of the de- to secure a comiiplete accomplishe(d
sion of the finger was
vascular supply from the face to the finger. D)ivi-
gradually, with the samiie end in
pressioi. wvere remioved, and the cicatricial tissue aloneskin. coul(d be seen;
hut it wvas perfectlv oni a level wNith the snirrouimdin(T In texture view ; and when the bone was divided with the bone-pliers,
both ends of it bled. The patienit did
effectinlg
nlot suffer
and ini appearatnce this cicatricial tissti haid so much improved, havinig complete separation,constraint.
lost its shliiny, imeillnranous anld vascular character, and(l become
tlhickenied an(i of ani opaque white colonu;, that it closely resembled the
from the proloniged The transplanted phalanx rctainled its
vitality unimpaired. Further operative details were subsequently had
sirrounling slkin. the first case, xxwhich had resulted from a bullet- recourse to to unite the ak-c and columna the free enid of the finoer,
writh completed,
and to remove the nail. When these steps wvere
In

-wounl, and( a portioIi of the malar boiie ha(l been carricd away, al-
the trans-
tlhou(ghl the (lepressioni cotuld not be entirely obliterated, very great in- plante(d finger itself presented a very fair substitute for the niose ; but in,
provemnient lia(l rcstulted from the operation. Ihe permanienicy of one the the coturse of a few wxxeeks it had receded to some extent into the cavity,
operation was placed beyond all doubt by the two last cases described, so that it w'ould still be necessary to carry out the original intention of
ninie, anid the other nearly three years since thle operation ; andl the covering it wvith a portion of skin. It was thotught, however, that, in
suitable cases, the finger itself might be used to form an adventitious niose
comlpleteness of the obliteration of the depression ; andmost the improve-
without further covering. In the event of the operation being again
melit of the cicatricial tissue surpassed Mir. Adams' sanguine
expectations.-Mr. LuN) (Mianchester) had a case some time ago in a undertaken, it wasmeans recommended to use a longer portion than one
young geiitlemain wlvo lost a portion- of the bone below the orbit, a de- phalanx, to adopt for narrowing the orifice of the cavity, and to
presse(I cicatrix being- left. lIe had operated without MIr. Adams's im- be carefuil that the finger did not become twisted from a perpendicular
provemiienits ; and, -% hen he sawv the case last, the cicatrix ha(l fallen back. line during the process of union.
to its old state. The patienit wished to be again operated on; and, te of Sti- Ontl Treatnieunt
EntlaZ-cmenIs of London. mmiozns MTACKENZIE, Ale Glnelds by1/3/l 0
aithouglh he w-as uinw-illinia theni to dlo so, yet he might with Mr. Injections. By MORELL det^-nii had reference
Mr.D., prinicipally--The
Aclamis's needlles give him a furtlher chanice. Ile would like to know authorcommenced by stating forhisit paper that to
what dressinig Mr. Adams used. lie thought that, in suclh cases, the disease of the cervical glan(ds,
was in that situation that it was
disfigurement. writhout
cavity miiialgt lie nicely filled up with blood-clot, the uses of wlhich they most important to get rid of the enlargement
had seeni in Mr. Lister's clemonstration. It wvould be important to pre- had Piactitioners alvays
found great difficulties in dealing with
The author stated
tlhese
vent suppuration ini the linle of the needles.-Mr. ADAMS dlidl not use cases, as treatment often exaggerated the deformity.
aniy dressing- except collo(lioii in olne instance. In onily cne case that, as the results of his experiments with many differelnt solutionis,
had he aiiy bleeding. lhe n-eedles were removed on the third clay, he had the dilute acetic acid the fouincd valuable As a
where several glands were affected,
mllost remedy.
wxitlh a little suppuration in one case, bLit none in the others. The rule, he injected once a week ; but, if
only difficulty he had was in avoidling veins.-Dr. HIARDIE (Mlan- the injections could be made more frequently. It was desirable,
could niot
chester) had foundl difficulty operating
a in on depresse(l cicatrix by one possible, to cure by absorption ; but sometimes suppuration
punctuire. At MTr. Adams's suggestion, he had so treated a case of be prevented. In these was cases, the pUs should be drawn off a fine by
(lepressecl cicatrix over the malar bone large enough to admit the aspirator. Suppuration apt to be followed by the oleate ofofmer-
these cases,
the thickening
little finger. It had beeii unisuccessful and he hadc, therefore, dis- walls or outer portion of the glands. In The
sectedl the cicatrix outt, ancl by wire sutures brought the edges together. cury (ten per cent.) was most valuable.
author then to proceeded
A smiall linear cicatrix only remained after thr-ee years; andl there was quote in detail some of the thirty-six cases he did not believe had treated with
that the
wvhich lhe
nio recurrence as in Mr. Lund's case.- Ir. ANNANDALE (Edinburgh) acetic acid. Ile concluded by stating that
lhad listenie(d with gi-eat pleasure to the paper. Mr. Adlams had been cure of these cases rendered the patient where more liable to plhthisis. lie
very successfuil ini his tw ro cases. Fromi his oxvn experienice, he slhould had seen many cases
of phthisis glandular enlargements
develope
have lhesitated to initerfere itlh the cicatrices so freely, from fear of had existed untreated ; but he knew of nonethe otherpulmonary disease
cases. Oni stuch
hand, he
wlhere thouglht
sloughinig. It as initeresting audI cturiotus that, in M\Ir. Adlams's cases, had followed the cure of
there Nvere suicli bad results. Oni the whole, he preferred Mr. that phthisis was more likely to follow the splontaneous breaking down
no

Ilardie's metlhod, if it did not remove too much.-IMr. LiSTER thought of glandular tissue.
that the plan wvas uindoubtedly itngenious ; and there could be no harm the Bone
f`vo Cases rfntndPuntctured-e one in to/li, the FT-onto!l
Pro'fc/tire (f
olher- ti-e/edl b/i
in t o,71 Loss of
clone if, iII the (lissectioni, nio veiiis wvere wvoundled. The operatioi xvas
sulcutaneous, anid the pins pressed oni soun(d tissue. Elzxperience would
Tre/thiuting; resitfiti,t
Visiont. By KEISl}BURNE KING, I.D., F.R.C.S., lIull.-In the first case,
show if t}e cuire wiere permiiianeCnt. Ile hiimself would prefer to dissect the accident arosefrom tlle kick of hiorse in the left si(le of the forlehea(l.
a
udSin-ig bhitton-sutures, primiiary uilioil Aw ith a liniear A punctured fracture of the bone was the result. For some time, nio
out the skinl, and,
cicatrix.-MIr. Al).xais had ctut out the ccatrix
get

in oine of hiis cases. serious symptoms arose. But, a month aftcr the acci(lent, Dr. IKinig
There was niecessarily, however, a scar.-Nir. LIsri id didl nlot quite trephiinedofthethebone, an(d
oni account of head-symptoms, remov ed
initernal plate of the skull whiclh projected throtugh the
tlhree
tindcrstaiid hoxv ther-e was 1i0 scar in M,r. Adams's cases. Ile thoualit portions
membranes into the substance of the brain. Abscess and herniia
cerebri
there miust be ani imp1)roved scar. -MIr. ADAMS expl)ainedl that the scar
became thicker aild less conispicuous, becatuse miiore like tl-ie surrouniding followed; but eventually the patient recovered, with, however, loss of
textures. vision from atrophy of both optic nerves. The seconid
case was that of
A lziiitopln/.icf )/a/Piint. By J. 'Di)iE,
MMl)., Manchester.- a sailor, who fell into the hold of a ship, otlher
ancd receivedl, amiiongThl-ee
D)r. Ilardie read p)aper
eo of lose, for which he hadl devised
a case of loss injuries, a puncturedl fracture of the left side of the forehea(l.
a new operation.
a
Thlie patient wtas
aged sixteeni, -who had lost her
a girl
firom disease. The whole of the organ lhad been
weeks after the accident, Dr. Kinig trephined the patienlt.
Notwith-
standing this, a most serious train of symptoms set in, including para-
nose in early childllhood,
deitroyed, -% ith the exception of small portiolns of both alx anid of the lysis of all the limbs,lossexcept the left arm ; hyperrestlhesia
of the legs
of speech, and delirium. This patient ever tu-
columiia, and the margin of the resulting- cavity wvas covered by thin blindness, deafness,
white cicatricial tissue. The principal difficulty to be overcome was ally recovered, with blindness of the right eye, caused by atrophy of
 AuguSt 28, I875.] THE BRITISH MEDICAL 7OURNAL.
the optic nerve.- fr. Ni,1i1,iR (Cranleiglh) said that, as the result of
experience of tw o ca ;cs, l1e believed that treplhining-, thiouglh easy at the
time, yet presented after-ditticulties. In one case, suppuration occurred
uin(ler the dura matcr, anid the patient dlied. In a similar case, he would
not lhesitate to malec free incisions.-MIr. W. Ai),Ims (London) felt
dotubtful as to whIether the fractures should have been ter-med pince
ttur-ed. Tlhey -ere r-atlher depressed and comminiutedi Punctured frac-
tures were pro(l nceedlby a spike, pitchfork, bayonet, etc., lbut niot b)y the
ksick of a horse.- Mr. Iis,rER (Edinburglh) remnarlkcd on1 the initerest
Of the cases. '[he douhle visioni with onie eye was
very remarkahle.
'Tlhe practical lesson was to slow the impeortaince of Syime's irulc of tre-
plinning in stuclh cases, without aiting for symptoms.. As to the ter-miii-
nology, ifa fi-acttr-e were caused by great violenice, anid the external hole
wN-er-e small, it coild he termiled punIcturecl. It was unnecessary, how-
cevr, to sticlk too closely to term,.-Dr. KIN(G sai(l thelc would be
somiie lhesitation in trephining a lad who rode tw/o miiilcs for a(lx ice after
the accident. As the result of his experience, however, hie thiouglht it
15oulkl be good to tr-ephine in all cases of pulictured fiactui c. In re-ard
to wNvhether it should he termalel a punlctured or dlepressed fractulre it
was really a matter of fact ; and(l he shotdld tlherefore hasve hiroulht tile
i.)ecimiens witl him. All the mischief wR!as catisedl by the splintieing of
the iinncir table, andl lhe thouglht puncttired fiactur-e a good niamle.
Cons0-70/lir' An11-al .Sur< 73'. 13y JA IFS 1P. Ca\s s, I.i,s, 1\.D1)., Glas-
gow.- D)CiniiiagaIIral sigery as surigical comm1111on0 ISe rightly ap-
sen
plie(l, 1)D-. Cs'.xellsits insisted that, inasmtuch as all initelligcneit sin-gey was
oLuisLrvative in oiiiis, anioal stirgeiy was
so likewise, hecause aural
sturgery was simpaly greneral surgery, plits special knole(lge. But this
claim did niot rest oni iniference alone ; for it was capable of proof that
aurlal sur-ery possesse(l this principle, andl that it did niot exist as a
scietitific pursuit if it laclkeed it. WN'hile he aelmiitted that the prilnciple
did niot alI-ays arrest the passing attentioni in genieral surrgery, it was
otherwise in the surgical treatment of the (liseases of the organs of
special sense, becatise normal funiction in them depeldel upon the com-
plete integrity of their tissues. Apart from this, how-ever, there wvere
special reasons why aural sturery w-as pre-eiwinently conservative; these
we e : I)iseases of the ear did not tend of themselves to niatural
i.
cture, bhut to become progressively orse, aeld more serious in their con-
seqtlcnces; 2. Of these eliseases, onily those w-ere preventable and
curable that a(diwiitted of surgical treatmenit. These conclusions wvere
the outcome of his owni experience andl observation. Regarding the
conaestive (liseases of the ear as those in w-hich sur-gical treatment was
demnande(l, lic considered them the only ones in w%vhich the conservative
priinciple was al)l)iical)le, and that early inlcisionl of conigesteel tissue
was the fotundclation of conservati-e aural surgery. Accepting exanth-
emiial catarr-li of tise tympanum anid its appendages as typical of these
conigestive affections of the organ, he sketched its niatuLral history, and
pointed otit the two stages in its progress in which aural surgery, as a
pieventive allel preservative m-ietho(d of treatmiient, w-as specially inldi-
cate( urginig its a(loption upon the attention of those lpresent, on the
gi-ounls that this disease, in its initial stage, wvas capable of being
arrested, and( that, in its later stages, its ravages wi-ere limitable by the
proceeding whliich lhe recomml-eim(le(l to their niotice. While lhe directed
attenitioni specially to this disease as the onie in wlisich aur-al sturgery,
as a coiiservative measure, Ns-as applicable, lhe desired to say that its
application was niot conifine(d to it, but wvas called foir in all the coinges-
tive atfectionis of the exter-nal ear as well, otit of which many serious
complicationis arose. Ile then referrrecl to paracentesis of the iwiem-
brana tympani as the operation representative of consers-ative aural
surgery, becatise this principle was first nioticed in connection with the
treatmenit of the disease, the history of w%vhich he hadl sketche(l, by the
operation wvlicil lie ha(l jtist name(l, ancl which he isowN, r-ecoiwmnielcd(l
to the profession, ith certaimi miiodificatioins based tipoin all(l suggested
ly a mloreC pcrfect patlhological and clinical kniowledne. Ile thien
g>lanced at the Ihistory of the operationi, which was, indee(l, the hiistory of
the origineof the principle of conservatism in this dlepaitmlent of miiedi-
cal science; ai;di coinclude(l by sayiilg tlhat the aims of aur-al surgery,
whlethler exhibited il siiwple inicision of coingested tissiie, or in tlle more
pretentiouis operation of paracentesis of the membraila ty-ipaini, were
to prevenit and to preserve, aidel that it sas misapplied if eiwployed for
any other object.-Mr. LUND (Manchester) askeel tlhe formn and direc-
tion of the incision in the membrana tymplani, ailel the kiilel of knife
used. Mr. RItVINGsoTN (London) said tilat Dr. Cassells' proposal wvas
11o novelty, as it as merely an extension of the plan of ctittiig- through
the illellbrana tympani whlen fluid as effused into the tympanlic cavity.
w next p)roceeded wvitli, tlhe graduiations enabling the ohe rator to calculate
It restedI with the general practitioner to carry ouit the suggestion, as
the aural surgeoii onily saxv tlhe case wvhen the mischief was irreparable.
They should, tllerefore, examine the state of their patients' ears during
the stages of scarlatilla. Specialists Nvere now enldeavouring to press
their specialismll on the geileral practitioner ; and this would certainly
26I
be a benefit to the public.-Mr. L NNON I3RONVNE (London) agreed
witil Mr. Rivington as to liis views on specialists. The latter dld ilot
see cases until the mischief as (lone. They were, therefore, -iateful.
to Dr. Cassells for (liiecting atteiltion to a illieals of pDrevciltiilg tliosc
sequeke of wllicll otorilucea xvas the 110ost faxvourable, aill was even cx-
pectecd. He agrecd wx itli hlli as to incisioil wlilere there was ptus- btit
he eloubted if tile geileral llractitioner xxvould iiicise lbefcre fltil(l col-
lecte(l. 'lihe iilcisiori by thie kilife llacl the advantage over tlle l)crfora-
tioll by ulceration of hiealiiig rap)idlly.-Dr. CAcSSELILS, in reply, related
the case of the child of a meclical mani brouilht to Iiil after r-ea(diin-
one of his papers. Tlle llearig- in oiie car x-vas gonie ; but, Ily this
olperatioil, that of the other xx-as savedl. IIc elid iiot lay claiill to oiiin-
ality, as the operation h.a(l been iiltolodticed by Saludlers, tile fatiler of
Liiglish auiral surgery. Ile himself Ila(i poinited out the (lefillite stages
at wxhich the operation silould b)e don-e. In scailatilna, the iilCisi0n
silould alvays he miaele blefore the fllid accumulated, so as to -et reso-
lutious. \Vllen in geilei-al practice, lie Ilad alxx-ays acted oil this rule.
As to the operatioiu, lie did not, fiom -ixant of tiiiie, give pirecise dce-
tails. They could lie fotllcd ill the Gl/sotzoo J'o'ical 733//7 Iofor 1872.
The illcision shoul(d he made from top to bottonl, in the llidlle of the
posteiior llalf of the t) impani, beliinil aidle parallel to the
haildle of tlhe mallelis, ilemlibrana
as fllid collected behind in the llnastoil cells.
Pw'i-incsa/ Suioei5) in /Sclandl, i/l/stshteul /l'c(as's 17t'0101 inz /sh' .4/1a
I/0Sy6i//71. By PE TER BROTItIERSiON, F. R.C.S.E3c1., Ailoa.-llTllos-
pital has beeil iln existenice for the last six years, aidld is situiated oil risiilg
grounci, a little to the north of tlhe tOwxi of Alloa. Tlle poltilation of
the towvn is albout teii thousanld, andi tlsat of the counity fouirteen tiotu-
sanld; and the buildiing lhas beeli founid completely adiectuate to tile xvalnts
of the locality. lhe surgical liospital consists of twvo xxards, wlith six
heeds each; aiid a sllmall room for secltisioln, Ivith txxro beds, an operating
room, kitchlen, ilurses' apartments, etc. TThere has eCeni 110 difficulty
in procurinlg ftin(ls for its iilaintenaiice ; alnd the erection of siuiilar in-
stitutions wvas urged wvherever nleedledi, from coiisi(leratioil of the favour-
able results that have beeil here ohtained. During the six years of its
existence, there liaxe beeni treated in it ninie fractures of the radiuis and
ulna ; four fractuties of the necik of the hullmerus ; txvo fractuies of tile
humerus; ten fractures of both bones of the leg, fouirteeni fiactures of
the tlii-h, and one compound fracture of the thih, all of xhlich re-
coveredl. Often amputatiolis of the tbigil, eiglht recox erel. Of four
excisions of the knee, only oiCe di(d xvell. Of four amlputatiolis of the
leg, twvo amputatiolis of the arill, tllree aillputations of thse forearm,
twenty-four ampllutationls below the carptis, fotir excisionis of tlhe marn-
mal, one case of lithotomy, oiCe case of extirpation of the testicle, all of
,vihich reco-eredi, as xvell as tlhe ordiniary aimlount of siillaler cases, I
need not specify. The average anlnual eixpenditure h-as beeii about
£250 ; and the w%hole or-igiilal cost of the institutioil vas /1,270, in-
clucing furniture, etc. There xvas built in conlilectioil ithl tile suigical
hospital a house for the treatillent of infectiouis dlisca es ; aisld it is, il
all its arranlgemenits, entirely separate. It consists of t\wo xvards, coil-
tainiliilg in all fourteeil he(ls. This separate buihdldig is plartly llmaiil-
tained by tlhe Burgis and P'aroclial B3oard, eacli contributilg /-Io
and it has been fotiid( of the -reatest service, on sever al occasioils, vs-heii
Alloa xvas thireatenedh wvith aii iiivasioli of smilll-pox aillI typlius
fever.-Dr. G. HI. B. MAeCLEOD (Glasgoxv) relllarkeed Oli tlle ilterest of
the paper as showvilng the illnlimelse lenelits of such plrovincial ilos-
pitals. As the surgeon, bovever, of an infirnllary once fe(d froiii Alloa,
but iowv liarely gettingi a single case from it, he hardly sass the ads-an-
tages as strongly as Mr. Brotllerstonle diel.
A.roU () } lw/Ioz Jo;- Un nnile,/ Ii'( .. By AM ciTT EIEN' HII ,T,
F.R.C.S., aid(I M\.lR.C.lPl.Ed., Bootle, Liverpool.-lihe operatiol (le-
visedl by Mfr. Ifill for the cure of tuiltilitedl fi actures conisists, lilkc
i)ieffenlbach's, il (driving- isory pegs iiltO tile fragilleult, but is (ditferelt
iln all othier respects. Thie old operatioil Ciltails a lar-ge xx-otli(l in tlle
soft parts aniclexpostire of tlhe bouie, in short, i-ei(leirs thse fractuire
comllpoulndl"; in tue iiev Opleratioll this is avoielcdl, thie pegginig being
eloiie sub)cutaiieotsily. Tlhe necessary tools are ani Archilllcteaii-screwv
dirill-stock wvitl two or tliree (drills, aldi ixoly stilettes about fotur or five
inilces hong. The drill alnl stilettes are silllilarly graduated in half
ilches, an(il the ivory is, llmoreover, grooved like a director ill ordler to
facilitate its introdtictioii alolngsidie the dril, aildl afterxx-ar(ds to alloxv
the escape of inflammiatoiy flui(s, wbich might otlerxxvise be penlt up in
tlie olony fragmelnts. Tlie 1o1(17/s oJpe0-an?i consists ill cilterilg tise drill
tllrotull a punctutre ullade by a tenotome ; thie boliiU- of the bone is
bis depthi to a nlicety. Thl e ivory stilette is 11055 filecl transver-sely half
x-ay throtughs, at a clistaisce from the point corresponding to the delpth
of the isole in the bone ; it is next slidldown beside the cldill, w hiich is
then withdraxx-i, the stilette slipped into its place, lightly llaillnlered,
and with a sharp twist broken off at the notch, flusihwith the surface of
 262 THE BRITISH MEDICAL
the bone. The remainder of the ivory is now withdrawn, and the punc-
ture sealecl with a strip of plaister. It is obvious that as many pegs
may be introduced in this manner as is thought desirable ; in the
author's case tliree wer-e introduced without causing any subsequent
misclhief or the formation of abscess. The punctures healed kindly and
b)y the "first intention".-Dr. G. H. B. MACLEOD (Glasgow) said
that the operation was undoubtedly something new, and he only re-
gretted they clid iiot know the end of the case. For his own part, he
had secii such admirable results from the antiseptic treatment of open
wounds, that he preferred to cut down on suclh cases antiseptically.
Mr. Ilills method, however, was miiost ingenious.-Mr. J. D.
RISON (Edinburgh) (dieew attention to his modificationi of the Arclsi-
7OURNAL. [August 28, I875.
the bones, ligaments, and glands of the cervical region, and by cica -
trices of burns antld wounctds; 2. Those having a conigenital origin,
which exhibit more or less rigid contraction and(t structural shortening
of one portion or the whole of tlse sterno-cleido-mastoid muscle, ant
which present considerable analogy wvith congeniital c'lb-foot; 3.
Spasmodic wry-neck, incduced in midIdle life from derangement of the
cerebro-spinal nerve-centres. The treatmiient of cases due tolpast or
present vertebral disease, and of burn and cicatrix cases, demrnnds more
or less elaborate mechanical aid; whilst those arising from con-enital
contraction ofteni requiire stubcutaneous division of one or botlh portiot5s of
M1OR- the sterno-cleido-mastoid, anid the subsequ llt use of a commiioni roller and
plaister bandage with a leather-paddelI collar onl)y, made higher on

miidean screw, by -Iiclh onily onie land was needed, anid greater deli- the contracted side. Phloto-raphls illlustrating, eaclh of tlle-e foimils of
cacy of touch seCnred.-Mr. LUND ('Manchester) had tried the method wry-neck before and after treatmnent i-c-e exlibited.-Mr. Fot hi -Ii
of drilling bones, but bad become dislheartenedl. Ile used a five-sided (Hanley) asked hosv the incision was made.-D1r. replieed hlat
b-oach Alr. Morrison's ingenious instrument 'would be a great lhelp.- he divided the tenidon about onie iniclh above the clavicle, wvlcre tl-ici
Mr. ANNANDALE (Edinburgh) had found the common bradawl or pricker was the deepest arch below it. Caie should be taken that the assistant
of the joiner to woik as wvell as atiy apparatus. It was chealp, in ad(li- did not pull too hard.-.Mr. GR.A 1A-m asked if, in spaslmoic case
tion, only costing about threepence.-Mr. HImr, iu reply, said that the there was anly returni after operation. In one case lie liad opernted
drill-stock was a minor point. The important fact in the operation on, there was nio return twelve monitlhs afterwards.-Dr. LITILE hiacd
was its being done subcutanieously. had a case of recurrenice tw-o mnontlhs after operatioln. In tliese cases,
Ont S-Ctioss of the Cor-nea ini cees-/iss Disat(ss of the E/ye of litzf/Zi- according to Langenbeck aind Strontieyer, the kniife acte(d as a niarcotic.
m1a/ou)' 0Oninl. By J. VOSiE SOLOMION, F.R. C. S.E., Birmingh1am.- He did not meani to questioln the accuracy of Mr. Grahlam's observa-
The late Mr. Guithrie recommenided that large collections of pus in the tion, but yet congeniltal wtry-neck often- appeared like tthe spasmiiodlic
anterior chamher shou!d be treated by a free vertical incision through form. In the unmistakably spasmodc)lic caSes, division (lid little good.
the cornea. Mr. Solomon tried tlsis plan in a case in I852; but the -Dr. PIRRIE (AberdeCen) iad listenied w-ith great pieasUre to I)r.
resuilt -was unsatisfactory, probably because the operation was too long Little's paper.
deferred. In I873 and 1874, he successfully treated by free incision iV'Otes the Mode;n Jdeltsodtls (tf Ext-s oeC/
on Co/crelw . By C. B.
several cases of extensive hypopyon, abscess, and diffuse purulent infil- TAYLOR, M.D., Nottingh11amii.-Since patients suffering from cataract
tration of the cornea. Tlte general results of hiis treatment were, im- were operated upon by extraction, nio method, whlell successful, hiad
mediate relief from pain; preservation of the curve of the cornea, and yielded more brilliantresul.ts than Daviel's processof removingthelens by
consequently lessened astigmatism; the prevention of synechia anterior making a flap of onie-half of the cornea. The fatality, however, attending
and staphyloma; and limitation of the resulting leucoma. The cicatrix this operation, even in the most competent hands, had led to its abandoni-
formed merely a thin white line. Several illustrative cases were de- ment, and the substitution of various alternative measures. One of the
scribed. first of these was advocated by Mooren, who proposed to avoid pro-
Ont the T-eotsesnt of sosne Diseases af/erting sionultaneously the Voice, lapse of the iris by excising a portion of this membrane some weeks
Speeh, ad lsing. By LENNOX BROWNE, F.R.C.S.Ed., London. prior to the removal of the lens. This rendered the extraction much
Subcntaneous 0Ocratioujoi- theRelief o/ li/)-ous Anhylosis of the znee- safer, but it involved two operations, and the risks attendant upon the
-7oint. Ey C. F. MAUNDER, F.R.C.S.Eng., London.-The patient large flap remained ; henice Schufte began to extract through a small
was a man, aged 33, Who was admitted into the London Hospital, on May linear incision, lifting out the lens with a spoon ; this was abandlolned
12th, 1875. Albout three years ago, the right patella was broken into for the more scientific methods introduced by Von Grife and the author
three pieces. The knee lhacl been stiff ever since, and lhe had injured simultaneously [See original paper by the author in Op/uth/omic leviewo,
it on two other occasionis. Amputation had been suggested. He I865.) These methods reduced the immediate loss from upwvards of ten
walked like a man with a wrooden leg, swinging the right limb iu a per cent. to about three per cent., and diminished the partial failures
half circle. The joint was the seat of firm fibrous ankylosis; the frag- one-lhalf. Thc pupil, however, was sacrificed, and in order to combine
ments of the patella, and the tibia and femur, being immovable one the advantages of a perfect pupil with the safeguard of an iridectomy,
upon the otlher. On AMay igtlh, the patieist being under the influence the author excised only a small portion of the periphery of the iris,
of chloroformiii, Mr. AMaunder forcibly flexed the leg, the adhesions leaving the pupil unitouched. This operation yielded excellent results
breakiing audibly. Thei-e was considerable swelling and ecchymosis in the auithor's hands in upwards of tlhirty cases, and had been highly
afterwards; bht nio good resulted. On June 2nd, the fragments of the commended from results in his ow-n practice by Mr. Brudenell Carter.
patella anid their fibrous bonid of union were severed from the fibrous The process, how-ever, wvas delicate and tedious. To avoid the flap,
tissue occupyinlg the joint. A strong. tenotomy-knife was enitered on retain the advantages of a linear incision, and still save the puipil, 1)r.
the innier side just above the patella; anid, the desire(d sectioln being Kuchler of Darmstadt extracted through a wound made directly across
nsade, the w-ounid was close(d ini the uisual way, as iu teniotoivy ; an(d the ceiitre of the cornea. Mr. Bader of Guy's Ilospital also practised
then the leg was forcibly anid freely flexed. On the fourtlh day, pas ise a similar incision, only a little below the pupil ; and Mr. Liebriech
movement was commenced, anid the patient was encouraged to practise made one a little lower still. Dr. Vincente Cliiralt, Lebrun, and WVar-
flexion an(I extension of the leg. On July 27th, he was able to lomont had adopted, in succession, exactly the same form of incision
perfornm hothl these iiovemeints, and -walked. Nvith a scarcely perceptible as MIr. Liebreicli, but placed it above the pupil. TIie autlior had
halt. nevertheless obtained excellent results in some cases with both the
O)st 0-5shhtiousho/ sssia outsd C oeua-act Colusp/icotions: nit/s Cases. lower and uipper forms of incision ; and his experience had been, that
By J. 1'. WoiLF, MI.D., Glasgow.-For tle last six years, Dr. the nicarer the wound approached the corneo-sclerotic junction, the less
WNVolfe lad adopted a new- miietho(d of treating that intractable dlisease. risk thele was of any of the evil results enumerated above. After maniy
The results were highlly satisfactosry, and bie relate(d the followving trials, and a careful study of numerous cases, both in this counitry and
cases: i. Granulation witls panisus of fourl years' standnhing ; coniiplete oni the conitinenit, he concluded that the safest form of inicision was a
cure ; cenitral opacity of cornea renmedie b)y foi-i atioIn of 1new plupil: transverse one at about the upper third of the cornea. At first, a por-
2. Granilation. Nwith double cataract, of nine ycais' (duiation ; cutred, tioii of ir-is Nvas excised as a part of the operation ; but, stubsequently,
an(d double extractiois succes>sfully performe( 3. Granular lids with the author prol)osed to dispense with the iridectomy in certain cases;
pannus, comiiplicated wsith traumatic cata' act; pannus cured, and cata- and afterw-ards, in consequence of the greater facility and conisequent
ract successfuLlly extracted. Tlse methold of treatmenit svhich ie adopted diminished risk attendiiig the various steps of the operation, a section at
consisted of: i. Scai-ificationi of the whole conijunctival cssl-dc-sac once tlhe low-er third of the cor-nea was adopted. In this way a shallow slit-
or twice a week; 2. Daily application of the syrup of tannin (two like flap was formed, comprising only one-third of tthe corn-ea, and
drIaclIms to one onilice). lying iu the corneo-sclerotic junction. This permitted the ready exit of
the lens throughl the natural pupil, and left no trace afterwards ; being
Fridlay, Asgssst 6/h. close to vascular tissue, it healed rapidly; any prolapse of the iris was
Professor PIRRIE, and afterwards MIr. ANNANDALE, occupied the readily replaced at the time, and if the pupil were miiaintained in a con-
Chair. tracted state by the instillation of Calabar bean, the prolapse did not
Ileesas osz the VuT si-leties of TV-'- neck, an-d its Trealoltent. By W. J. return. The wound healed in twenty-four hours, after which atropilne
LiT TL1, MI. D.-Tlhe autlhor described three groups of cases met with might be used if desirable. The operation was singularly safe, and
in practice: i. Those caused by rheumatic and strumous disease of successful as to the appearance of the patient and the power of vision.

Aukust 28, i875.] THE BRITISH MEDICAL
T'he Tr-eatment of S/pina If/id. By J. MORTON, M.D., Glasgow.
--Dr. Morton's paper oni spina bifida refei-red to the lhopelessness withi
-which stlch cases -were regardled previously to I87I, and stated that
many still regarded. them as necessarily fatal. In the autumn of that
year, a case p)resented itself in the w,vards of the Glasgow Royal In-
firmary, Which indulticed himi to consider wlhether he could not abandon
th'e do-nothing systemn, anol it was treated successfully by inijecting the
iwlo-glycerine solutiois. Since that time, six other cases had been so
tr'eatedI witlh a likSe reslult by Dr. MNortoni and others. All the lumbar
and dorsal cases treated hy Dr. MIorton himself hld(l heen fortuniate.
In onily three other cases had thle iodo-glycerine injectioI been used
and these succumheud, not fromi aniy direct effects of the operation ; one
w.as otherwise hopelessly (leformied anid paralytic, and probably not a
fit caso- for ainy initerfci-e ce ; anotlher dliecl from debility ; the third,
under I)r. Morton's owni care, (lied from convulsions due to the drain-
ing awvay of the cerebro-spinal fluid, wvhich mnight readily have been
prevented had the chkld been residenit in the hospital. So far as had was
kSnow-n, these were all the cases in wvhichi this modle of treatment
l)een employe(l. Collo(lioin, either comimn(ii or flexible, wYas used to
close the alerttires necessarily made, andl had always answered the
purpose. Ilitler to ses entv per cent. of the cases ba(l been cured, taking
even the wvorst viewr of the ceses; but, discouniting tlle paralysed and
tleforme(l onies, there mig-ht be abotht eighty per cenit. The mode of
managing them was describe(l.-TNIr. MlEADE (13radford) asked if the
early cases hadl been kept in view, so as t: see that there was no para-
lysis or otlher after-effects.-I MORTON saicl that lhe lad clone so,
)r.
and founId nio baXl effects follow ing. It was curotis, that innone of the
cases given was thelc anly pa.ralysis.-i\Ir. GRCiciAM said that the
genier-al expem ienice w\as, that one out of tlhrce cases operated on died.
Tlhe results ui(ler D)r. Moiton's treatment were most gratifying, and he
lhoped( that the good cffects w-oulcl continue.-TIr. ANNANDALE (Edin-
buigh) conigrattilated Dr. M\Norton oni his success. From a large expe-
rience of his ownv anid others' cases, especiallv those of the late Pro-
fessor Syme, he had coiwe to the coniclusion that interference generally
caused (death. Indeed, lattc-lv, Mr. Syme did not operate. In some
cases, he hacl seenl spontaneous ciores ; but the success of Dr. MIorton's
plan was imost his )r. PIRRIE (Abeildeen) felt indebted to
gratifying.- paper.
)r. Morton for valuable He had listened to it with great
initerest. I-litherto his opinions had been similar to those of Mr.
Ainniaid(lale. Dr. MIortonlisplain, lowevem-, opened up ltuite a new field.
Tii regard to pathological specimenis of spina bifida, he miglht menltion
tliat, in the Association f\ltuseutmm, a very fine slecimen of its occurrence
in the ltimbai region swas shownii by him. In it a vesicular piocess of
the sacral nemrses coul(d be seen passiing thlotughl the fissure, to become
a(lhereiit to the posterior w,vall.
.-1 Case o/ Sitmnous or- Tuber-cutlar- Diseazse of th/C B-cast sintulaltilg
LSCir-h/is. By R. Il. MI.tAE, F.R.C.S. Eng., Bradford.
1-urther Obse; 7ati0wuS ont tihe Elect; olytic Disper-sion of Tuinottrs. By
JULIuS AImn11AUS, M.D., London.--He stated that it was now
pretty well ascertained hat electrolysis could do, and what it could
w ALTHAUS said that reply was hardly necessary, as most of the speakers
not to ; and that its splhe-e of usefulness was not likely to be much
curtailedI or enlarged by ftitur-e researches. R,egarding the mode of
applicationi, he reiwarked that the voltaic current was conveyed to the
ttimours by means of gold needles, wlhich acted either in fixed rows or
sinigly, in any direction that might be required, by means of the
serres-fines conductor; anti that either the influence of the negative
pole alone, or that of both poles simtiltaneously, was utilised. Elec-
trolysis -was very useftLil in certaini forms of nxvLis ; and the author
pointed otit its advantages over excision, the injection of perchloride of
iron, nitric acid, the stubcutaneous ligature, and the galvanic cautery.
Cystic bronichocele yielded readily to it, and solid bronclhocele more
slowly. A remarkable case of the latter affection wvas relatedl, in which
the patient's life was in imminent danger from pressure of a rapidly
growing tumour oni the preurogastric nerve. Sir William Fergusson
hiad refused to operate, but the patient got ultimately quite well under the
author's care. Sebaceous tuimours yielded readily to electrolysis, which
,was likew^ise useftul in recuirrent fibroid and secondary cancer. It was
not possible by this means to eradicate the cancerous diathesis, or to
prevent the tendency to (leath; 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 whiclh the suffering had been intense ; but where the
last few eeks of life were rendered perfectly comfortable by the use of
w the practitioner witlh perforation of the soft palate, who had never
electrolysis, the patient ultimwately sinking from congestion of the ltings,
brought on by e.xposuie. The author wound up by requesting hiis
hearers to use electrolysis more largely in suitable cases than had hitherto
been done, 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-
263
_OURNAL.
ment, which, he believed, would come still more into use. He himself
had considerable experienice of its use in the treatment of aneurism and
nievus. Ini certain cases of aneurism, it was admirable. In aortic
aneurismii, however, it was disappointing, as, although it gave relief,
yet it did not cure. It wvas certainly best in cirsoid aneurism, or
aneurism l)y anastomosis. He had referred to the treatment of nxevus
by this plan ; but for the plethora of papers in this Section, he svotld
havre made a written communicationi on this subject. The method
was perfectly safe and certain. It had the disadvantages of leaving a
scar wvheni performed too quickly, and of being tedious when done too
slov.wly. 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 niot matter, somethinig more rapid should be used. In the treat-
ment of other tumours by it, he had little experience. He found it
extremely tedious whlen done slowly; and, -when done quickly, there
was risk of slougrhinig. This was nothing mysterious. When done
slowly, there sas destruction of texture and then absorption. But,
when it wvas too quickly performed, the destroyed texture came awvay as
sloughs. He had used wvith 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. Iln 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 neclk(primary), wvhichl he had seen
through the kindness of Dr. George Balfour, there was great pain; so
that the patient cotuld not sleep for more than ten minutes. After the
operation, however, he got r-est 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 betveen causing increased rapidity of growth
and givinig relief to the patient.-Dr. J. C. HuTME could confirm wvhat
Dr. Duncan had said as to the use of an insulated needle. His expe-
rience was limited to two or three cases of navus in the face. In the
first, the neevus occupied the extremity and length of the nose. Un-
fortunately, the child dlied from bronchitis. In the second case, the
nxvus 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 bridlge of the nose, onie cheek,
and both eyelids were affected. In none of these cases was there any
scar left.-Mr. LENNOX BRONNNE (London) was so well acquainted
with Dr. Althatis's treatment, that he could bear testimoniy to its
effects on r.revi anid the softer forms of enlargement of the thyroi(d body.
Its advantages in treatiiug the latter form of disease, viz., preventing
hcmorrhage anid leaving no scar, he had omitted to mention, when
speaking on this subject at a former meeting of the Section.-Dr.
BuclhANAN (Glasgow) did not feel qualified to give a general o)inion
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 fewv instances in which it was not applicable.-Dr.
had agreed with him. He w^as especially pleased with Dr. Duncan's
remarks. In regard to electrolysis causing increased rapidity of
growvth, they should remember that Dr. Duncan's case was a primary
cancer; whereas it was in seconidary cancer that it was most applicable.
Teitia;y Sore. Th-roat. By C. R. DRYSDALE, MI.D., Londoll.-Ter-
tiary sore-throat was readily divisible inito two forms: I, the ulcerative ;
2, the gummy. Thlie ulcerative form of tertiary sore-throat was seen
chiefly on the tonsils, or posterior wall of the pharynx, and svas com-
paratively rare. It might occasion discomfort in svallowing,", anid pain
in the ear. It might be extensive eniough to remove the whole of one
tonsil. The gummy tumour of the soft and hard palate was the com-
molnest, perhaps, of all the symptoms of tertiary syphilis. Gummy
tumouir of the velum commenced by the depositioln 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 substanlce. In a short
time, the inflammatory stage supervened, and the mllucotis 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. Thle
velum became immovable at the infiltrated part. The disease wvas
often insidious in its approaches. Patients not unfrequently came to
known the danger they were incurring by their neglect of the very
slight symptoms in the throat. 'When inflammation had once set in,
the disease wvent 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 mightoccur in two
or three days. It was, on this account, of the greatest importance that
. 264 THE BRITISH MEDICAL 70URNAL. [August 28, I875.
practitioners shoulul(i be habituated to diagnose at once the characters of needle passed or pressure applied by means of the finger. l-Ie thought
the tertiary sore-throat * sinice any delay in remedies exposed the patient that the risk of hcemorihage after the isiseur or galxano-cautery was
to two grave inifirmiiities. 'Tlhe first of these was the loss of voice, which maglified. lIe lhad niot used the latter ixi removal of the tonigue;
wvas in proportion to the extent of perforation of the velmn ; andcl the btit bad fouitil it of great a(dx-antage ix remoiing, xxvithout risk of
second wx as the iregurritation of food, and especially drinks, ly the lieixnorrhage, syplhilitic groxxvlbs of the genital organs.-Dr. GitAIIAiil
nostrils, wvlhen the perforation of the velum w-as not very small. The had usedl the galvaino-cauitery in extirpation of the tongue xxithout
loss of the voice wras sometimes almilost total. The reguirgitation of hrTmorrhage or any tintoxxard restilt. Ilis plan as to sexer the lateral
liquids was ofteni a serious matter, producing emaciationl and death from attachment of the tonigue to the mticotms memiibrane by meaiis of scissois.
astheniia. Perfoiationis of the hard palate from gtommy deposit wvere A straiglit incisloix xxas then mxadle froimi the clhin to the hyoinl bone.
also comnmon, andl proitLiced the same effects ; and were amenable to Txvo needles xvere next appliedl, so as to graze tlxe top of the hyoid;
the samiie i-emedy. In the treatment, caustics should nlot be lused in the aixld then, by nixeaixs of a platinum loop, the xvlole orgaix could be easily
inflainmations connectecl -ith guLmmy sore-tlhroat. Nor should such remioved.-Mr. ANNAN DALE (Edinbturgh) unnderstoo( D)r. Hirschfell
tumours be touclhed xvsithi the knife. What was indicated was the ad- to say that the epithelial formii of cancer, xbliCd chliefly affected the
ministrationi of the iodi(le of potassium at once, in lar(ge doses of fifteen tongue, had little teirheincy to spread. lIe didilot tlhink that this xxvas
grains four times niaily. Mercury in such cases wvas poxvcrless, or the case. lIe lhad operated ili many instanlces, anid fouixd that the
nearly so; anld wvas only to be tried when the iodide failed, w^hiclh it tendency to spread xvas veiy great. It most frequently began in tlhe
did in rare cases. lateral half of thle organ, aisd tlhelx implicatedi the mtuscles and mucotis
Tu'e Sui,g eil Ti-ealtiat of Ly,miphatic Tuatzoutrs of the ,A e. l'y S. memibrane. It xxas, ther-efore, a(lvantageous to opierate completely.
MIESSENLE BRADLEY, F.1,.C.S., lIanchester. Mr. 13radley limliited This could bxest be donie by dix-iiding the jaxx. Wlheii the clisease xxas
hiis paper to the conisidlerationi of certain iiuchal lymplhatic tumours, linitedh, the galvaino-cautery could be used; but there xx as risk of a
l hicli lie divided in1to tlhrce classes: i. True hypertrophies, xx-ith or xith- portionx of the (lisease being left behind. Althiouigh the galvallo-cautery
out a truiumouis diathesis, anid shoxving nio tenidency to break down or eilsured less ri]sk of hxlixmor-rlhage andl left a safer xouncld, yet lie pre-
under-o pathological chlang,e ; 2. Strulinoous hypertrophies, consisting of ferred first (livitiig the jax, so as to expose the tonigtic in all its coni-
celluitlar hyperplasia _ulus cascolis deposit, which, after a timlie, soften niections. Th'le galvano-cautery or t'Ci'WS4!enr coltdl( tlheix be uti St.-I)r.
either inipatches or cntirely, until the gland becomes a mass of soft HhIRsCHFEvLD, in reply, said tlhat lhe believcdl the preliiniiiary ligattire of
strunmous matter; add . Ilard inon-ilnfectious lymphomata. M\1r. the linguals to be a great help in preve-iting all lixmorrlhage.
Bradley said tlhat, as a rtule, these cases were lumpcd together and TecCiu -ishmnent (7f t/he Ileoul(/(tthe 1'-7mur aftei- In/-.-ic/St(/a(r- Proa -

treated grenerally, indiscriminately anld unsatisfactorily by the local tare. By F. OGS''sON, jun., MI.D., Aber(lecen.-After aix intoloductory
applicationi of iocliiie anid the initernal adminiistration of cod-liver oil, description of the state of palts in' ani oldl iiiuii-litedl initracapstilar frac-
etc. It xxas his wvish to suibstitute an arm of precision for this hit or ture, anld a short rexiexv of the tlieories xvhich hia(l beceix brotiglit for-
miss miiethod ; anid, fromii an extensive tiial, he -was able to say thlat, by a xxard to accotinit fir the healtlhy state in hiclt the hca(l of the fem-ilur is
proper selectioi r)f cases, this coutl be clone. For several mouithis he frequently fouix(l after this ihxjtiry, a third lnetlio(dl xas iid(licatedl as an
hart iiijecte(d the lharder lymnplhatic ttumiiours with a fexv drops of tinictlure efficient onie; x iz., that the heanl of tlxe femiiur is supplied xxith aix abun-
of io(dinie, with the almiiost ilnxariable result of causinig a rapid dimiiinu- daiit supply of bloodl by the capsilde reflected aloixg thie neck. Thlis
tion, going on to colcipletc absorption of the glanid. lIe had eveni suc- viexv xvas supported bxy quotations, by diagraixis, alid by refereixce to
ceerled in. producing absorption of somiie eiicapsuled tuLmoturs situatedl on iixjectioixs of this structure, shoxxilug tlxat bloodl-vessels pass througlx the
the salivary glands by this means, but confine(d himself at present to reflected capstile anid l)ierce the lieadl of the femxur, aixld that this coni-
recommniending this milode of treatment in hypertrophies of the lymphatic ixectiixg baixd remains uninterrupxted ili those cases x-hxere the liead of
glands. As a i-uile, txo or thi-ee inljectiolns of from fivxc to fifteen minims the -ione is fotmndl xell nourislxcrl, xxlile it is xvholly rupturedl vIieix the
of the simple (P.I.. ) tinictuire of iodine, xw-as sufficienit to effect a cure. No lxeadl of the hone is fovixdld to le xxastedh. The stateixcieit of I-irtl, that
other treatment xxas necessary. This plan hadl the advantage of beillng -essels do ixot reach tle lhea(l of the feimxur bxy tlxe rotii(l ligaixxelit, xas
comparatively paiiiless, safe, anid speedly. It xvas not applicable to all sho-n to lie iixcorrect, sixice ixi olie of the cases (Itiotedl the iiijection
lympliatic tuLmoiurs, anid, if used iid(liscriminately, x\vould fall into dis- eixtered it by this cllaiuiiel.
favoour anid distuetudte. 'To avoid thisi, lhe laid doxvi the folloxving rules Ont ibi-oucs Taaiioitnrs of the A i-icle. By J. J. KIRlK Dt;NC.\NSON,
for the suurical treatment of these iiuclial tumours : i. Cases to be M.Dl., Edinxbutr-lx.-Tlhe auricle is subject to a variety of rdiseases, aixd
ti-eatel by, /In/ection /-/ 1o(i'mI: a. True hypertrophies of cerx-ical glandls growvths of variotis kind(s are fouiidi aflecting differeixt parts of it, arising
witlhot scrofuila; b. Strumous hypertrophies of ceivical glancds before from tlxe dhiffereint structut-es of xvhxich it is compxlose(l. They mixay he
they have broken d(oxxn ; c. llard (nioni-inifectious) lymphomata; (I. All tiuxiours containing liyclatids, masses of fatty matter ; or they nxay be
encalpsulated tumiours, as a tenitative operation. 2. Cases tlo be tIrrt''( steatoixatous, sebaccous, encyster or fibrous tuixiours. Hypertrophy of
by lize liso(n: Lymnphatic tumours that have, either witlh or w-ithout the lobule, as xvell as ttibercles of a gouty nature, spi ead over the aulricle,
previotis inijectioni of io(line, brokeni dox-n into pus. 3. Cases of Ce;-- may occtir in subjects of a gotity diathesis. Elephxantiasis lxas leen
Yl'u U/io to be 1i' /ca' by
Llxti;syation wvit/ the IuIiie.: Stiumotis kinoxxvn to attack the autricle, aisrd caixcer of an epitlxelial inatuire affects
a.

glands hich foim tulmlouis ridclle(d xith soft patches, an(lrest- thie atiricle ilidlependently of aixy other seat iix the body. Fibrous
inig oni a b)ase of suppurating cellular tissue, wxith a large area of blue tumiiours of the auricle occur in the lobule of tlxe ear. They xave beeix
skin ; b. Encapsuled tulnotirs wvhich have resisted the treatmenlt by most freqLieiitly met xvitlx in the ears of the negroes of the Brazils, and
injection. some Afiican tribes ; hut they are to be met vith iln all cotxntries xhere
Serev C ebi-,o-^S/iiIz
e S n/to ms pi-o l /o
bytc a -anll (at JiOotbioll. By the piractice of piercing the lobaule of the car for the wvearing of ear-
P. Al. liE ioD, M.D., Birkenhead.-The symiptoms xvere pro- riixas or otlxer ornameixts is custoniary. Variotis reasonis are gixeix for
dtiuc(l ly fall on hlis back stulfered by a young lad thloighl missing- a their occtirieixce bxy rliifereixt autlhors. Accordhiixg to some, they arise
drop-kick fiotlall. Ile thotughft the
at case worthy of the attention of fironx tlxe act of piercing the lobule of thxe ear iii certaini coixstittitiOlxs
surgeons, as being a rare iinstance of severe neriots sym)toms being others,5 say they are catiserl bxy the irritatioln of the articles xvorn, stich as
catisecd bY a sliglht acci(leixt. brass earrings. Shortly after the lobtles of thxe ears have beeix plierced,
Onz a-tbaiopz1zn //Me 7)anewt. By JOlHN C. HIRSCtHEi D, M. 13., or ixot uixitil solixe irritatioix by the articles xorn, pain ancl sxxellilg sul-
Banff.- The auithor briefly comlmented on the various operations for the pxervene. These aie follo cr1ed by a ixiore (lefiincd sxx-elhiilg iil tlle track
removal of the toingute, and recommenn(ledI the folloxilng plail, as ob- of the punctule, aixd this sxxelliixg may bxecomixe a xvellhixarike( fibrotis
viating the irisk of hxniuorrhage, and( removinig variotis objections to ttimour. I'aget says there ixxay be, perhxaps, some dloubt xhether the
otlher procec(ings. I'llie lpatient havingc, been puLt unider- the infllcllce of groxvth be a prmoper ttiixiior, or a cheloid groxth of the cicatrix tissue,
ani anwsthetic, the lingual aiteries are tied. Tlhe vessel is expose(d by hormile(I iix the traclh of the ,votxnd; but it hlas the aspect of a (listinct
miaking aix incisionii aiiixicli anid a half or txx o iixches in length aoxve fiblrotus ttiiiiotir, aiil the slkii appears tinaflecte( ; thxey are recuireint.
an(d parallel to the great cointi of the liyoidI bone, turning tii) the sut- Accorndiixg to lillrothx, these tuxniours coixsist cliefly of spindlle-slxaped
maxillaiy gland(, and (rlixl(ling the fibires of the hxyoglossuis illuscle. The cells an(d coninective tisstie, aix(l are merely aix hypei-ti oplxy of the
miiouitlh is tlieni li enerl depielssing the loxver jaxv an(I thle tongrule is cicatrix, siixilalr to ttiixours growviixg fromix cicatniecs oni otlxer harts
tlheni clut tff close to the hiyoi(d bone. If the motithlie simall, the aper- of the hotly,(keloidh). St. Joliix Roosa calls tlixeixx fiiro-cartilagixnotis,
ture nixay lie eilarierl b)y cuttin- friom the anigle of the moiuthl inito the aisnl says they are a siimhple hxypei troplxhy of the iiori ial strtictirecs.
cheek. Ihe aiitluor belexvecc that epithelial canicer of the tongue liad T'hley OCctLir inuor-e frejitueixtly in fle Africaan tliaix ini the Caticasiaii race.
comparativ ely little tendenicy to sprearl.-Dr. JOI-IN DUrNCAN (Edinl- AJnit/ihe/i'c A1,n/s.-Oi1 tie plropiosal of rIr. ANNANDALE, the Sec-
burgh) saicl that the principle of preliminary ligature of both lingiual tion passedi a resolutioix r-ecomiienediixg thxe appointmenit of a Comnmittee
arteries xxwas a solirld one. Btit it must be remembered that, in almost any to iixquire into and report on the tmse of amesthetics. (See JoURN AL,
operations lneal the lingyUal, it could be easily exposed, annd an aneurism- August a4th, page 214, Col. 2.)
 August 28, 1875.] Y1HE BRITISH MEDICAL
SECTION D.-PUBLIC MEDICINE.
THE papers in this Section ha e been arranged in the following groups,
of which one as taken up on each day that the Section imet.
A. Conitagioni anid Infectious Diseases.
B. Mledical Legislation, Meteorology and Disease, Statistics of Dis-
ease, etc.
C. General Sanitary Arrangements ; Drainage, Water-supply, Ven-
tilationi.
WTVe-nesa(aj', AuguVfst 4t/h.
GRO(IP A.-CONTAGIOUS ANI) INFECTIvi-: DISEASES.
The P'resident, the Rvight 1Ion. LYoN PLAYFAIR, M.P., took the
Chair at 2 P.M.
Coztlril'tion to the Iife-histlory of Contagtinm. By P. MT. BRAID-
WOOD, MI.D., and F. VACHLER, Esq., 13irkeinhead.-Having carefully re-
viewed the literature of the subject up to date, including the papers in
the recently issued reports of the medical officer of the Privy Council,
the authors proceeded to give particulars of their own investigations.
The questions, it was the purpose of these researches to eltucidate, were
thus stated : (a) Whlat is contagium? (b) In wlhat manner is it gene-
rated or communiicated ? (c) WX hat are the conditions on which its life
or activity depend? The restults of inioculationis on eighteeni subjects
with water conitaining the soluble constituents of vaccine lymiiphiwere
recorled. It was explained that diffiusion was cffected in the mianner
adopted by Dr. B-urdon Sandersoin, but the diffusates were more con-
centrated than those used by previous investigators; anud the authors
submitted that, by testing the effects of the dliffusate first, and in nio
case vaccinating till a given time after making the abortive insertions,
they avoided a possible source of error with which the method of proce-
dure of Ml. Chauveau and Dr. Sanderson w-as chargeable. Of seventy-
two ptunctures inoculated with the diffusate, seventy-one failed entirely.
As proving that the exception to Ml. Chauveau and Dr. Sanderson's
experiments was valid, the authors tried the effects of vaccinating with
lymph pure and diluted simultaneously, anid found 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 w-eakened
virus. The conclusion arrived at on this point wras, that there is the
strongest inclirect proof(tlher-e canbe no direct prooftillwecanw,vash off all
trace of plasma from the bodies it suspends) that the contagium of the virus
with which w-e are most familiar, consists of particles neither soluble
in water nor in watery liquid. he next series of experiments reported
were for the purpose of determining some of the conditions affecting
the activity of the type-contagium. They consisted of animal vacci-
nations, retrovaccinations of cow-s and heifers, inoculations ith lymph
w commendations were illuistrated by reference to the epidemic of scarlet
preserve(l by different miietho(ds for various lengths of time, and vacci-
nations wNitlh mixtures of lymph and various so-called antiseptics or
germicides. As regards the results obtained from this last group of
experiments, it was stated that combinations of vaccine and carbolic
acid solution for sixty-four insertions yielded ninie vesicles ; that sul-
phurous acidi vaccine failed to produice vesicles ; that ozonised anid
chlorinised vaccinie also entirely failed ; that vaccine mixed -with a
saturated nieutral solution of quiniine-retained its activity; that a mix-
ture of lymph and liquor potass,c permanganatis (B. P.) gave dloubtfLl
results; that chloralum on beincg mixed with lymph did not affect its
activ ity. The thirdl seiics of observations referred to the local mani-
festations incidenital to vacciuation. The autlhors vaccinated a heifer
at several points, and clay by day remiioved successive portions of skin
where vaccine had been inisertedl. Sections, v-ertical auld obliqlue,
were theni made and tin(ged with carmiinle, these being stubjected to
examinationis with high audI lowv powers. The preparations and dcraw-
ings fromii them cre exhibitedh.
w such conditions arc known -which miiark out children exclusively as their
Ot the Aa teqt?f CoutaA-ion. By T. J. MIACLAGAjkN, AL)., Dundec.-
The autlhor first referred to what is hnown regarding conitagion, and theni
proceeded to show that the view wihich gave the best explanation of
co-existent facts is that which regardls it as consisting of minute living
organisms, probably of allbminous composition, possessing the pcsver
of or-ganic dleveld)pmeit ; alw ays reproduicing their own kind ; capable,
under favourable circumstances, of preserving their vitality for a con-
siderable period ; but spee(lily perishinga when separated firomll thcse conl-
(litioiis and freely exposed to the atmosphere.-The PRI.SIDENT sai(l
that long ago he wa-s a strong- advocate of the chemical thueoiy of con-
tagion ; and the most beautiftul specimnen of incluctive reasoning we pos
sessed was Baroni Liebiig's chapter on contagion and miasin. Modern
resear-clh, however, lbad giveni little stupport to this view. Thle -cry
specific character of contagion-its plowc of reprodulction-- was an1
argumllent in favour of the germ-thcory. It as as certain- that
whatever produtced scarlet fever would produce scarlet fever, as
that a dog wvould produce a puppy, or a rose-tree would produce
a rose-tree.-Dr. CARPENTER (Croydon) pointed out that, in
_OVRNAL. 265
the dilution of the vaccine lymplh witlh distilled rater, the
small quantity of alkali in that water might have rendered the
vaccine material iniactive, and hence followed the want of iesults which
iglht have followved w-ith the addition of some chemical agent such as
carbolic acid. As to contagion, he thoughlt it was to be traced to
some organic germ, Xvhich m-niglht, ulnder cer taini mieteorological or physi-
cal conditions, develope into one or other of the diseases to which the
human body was liable-Mr. J. A. WANKILN (London) pointed out
that, though the water used to diltite the lymph referred to in the first
paper was not perfectly pure, the experimnents were all the more cogent,
inaslmiuch as they proved that contagia were destructible by water.
This fact of the germ-forms losing their power iwas of very great im-
portance ; and, if they admitted the accuracy of these experiments,
they must admiiit the possibility of destroying every poison-germ by
dilution. As to the niature of contagion, wlhile not defending the
chemical theory, he held that, unless they could discriminate germs, the
germ-theory hla(d no vitality in it.-Dr. MACNAMARA (Calcutta) was
doubtful as to dliseases being alone capable of reproducing themselves
for scarlet fever was never foulnd in India, or cholera in Australia,
although both countries w,vere in communication with the West andl witl
each other.
Scarldt f-jrz,er: Iaow tof Pr-event its Spreaz d. Ily J. 'M. Fox, AM. R1. C. S. E.,
Alinaside, Cockermciouth. --The paper commenced with a statemenit that
facts in saniitary science are sometimes brought to light wsith greater
distinctness in small towns, where observatioln miiay be more complete
and conditions are less mixed, than in larger urban areas. An epi-
demic of scarlet fever during 1874 in Cockermouth had impressed the
writer with the convictioln that, in order to prevent the spread of this
complaint, it is essential that local sanitary authorities should, under
the advice of their medical officer, have the full statutory power: I.
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 or-der may direct; 3. To order the disinfecting ancd
lime-si ashing of such premiiises. lIe also considered that all dame-
schools and other schools, public and private, shlould, in regal-d to all
matters affecting health, stand to the local authority precisely as
lodging-houses and slauglhter-lhouses do ; and that it should not be
lawful for any school, pulblic or prisate, after the passing of a stattnte to
that effect, to be opened without a certificate signed by the Chairman
of the Local Authority, defining the number of children to be acconm-
modated in stuch school, and otherwise approving its general sanitary
arranigements. The paper strongly urged the Associationi to use its in-
fluence, in order to obtain these additions to sanitary IaNv. These ie-
fever in Cockermouth alluded to above. The towni hadl a good sani-
tary character, being well situated and hav ing a good system of sewer-
age anid a faultless water-suipply. There wvere but two deaths in the
year from typhoid fever, one from typhus, an(l nine from diarrhcea, fi,-e
of which occurred in the worlkhouse. There were two (leatlhs of adults
from (lipltlheria, one in a house saturated with scarlet fever poisoll,
and the other that of a butcher living near a slaughter-house n1owv
closed. All the other slaughter-houses wvere wsell kept, b)eing tini(der
frequent inspectiof. Not a sinigle fatal case of scarlet fever, cand v-ery
few of illness, svere fouind aMongst adults ; indeed, out of thirty-four
deaths, only four occurred under onie year of age, the remaining tlhirty
being between the ages of two and seven and a half years. It seemed
clear, therefore, that the disease did not follow the track of any known
sanitary dlefects, and that children, not younig infants, were the sole
objects of its attack. It -was admitted that the health of children is a
test of general hygieniic coniditions ; but not to that degree tllat anly
victims. Public conveyances and pawn-shops Xwere kept under rigorous
ovcrsight, and were in no case believed to have been the means of
propagating the disease. The difficulty of sending youtng children to
a lhospital for infectiouis complaints was felt. The fact that this caninot
be done inl many cases without seniding the mother-s also, proves that
this is not (quiite the kind of separation to be sought in dealing -with.
this complaint. Regarding this difficulty, and the age of the stufferer
from scarlet fever, wlhat is rather vanted is the pr-evenitioin of the
assemblage of children in all sclhools, especially public schools and
lame-sclhools. In the new codle of rcgul atioius published by the 1E(1do-
catioln Department in I874, there is a clause, page 6, specifying tlhat,
''if a sclhool have closed during the year ind(ler mnedical aultlhoi ity, on
accouniit of a local epi(lemiiic, a proportioniate ecluction is imadle froml
the nium;ber of mectings and(l attendances required', for the purlpose of
a moniey cal)italtion granit. If this provision cxist, whby nlot the pow-cr
authoritatively to inake use of it? anid if there is the powcr to closc
public schools, why not private infant schools also, whose sanitarv con-
dition is usually muich worse ?
 266 THE BRITISH MEDICAL 70URNAL. [August 28, 1875.
is En/e; ic Fe-oer everspo;tzt7/eonsi'.v, Geizertaed B?y CORNELIUS B. Fox, Onz Vililage Ontb;-eak of Enzte-ic Fever -lraceab'e lo a SSpecif/calj' Pol'-
a

M1.D., Chelmsford.-TlTe author remarked that the question of paia- lZne.l !Vater-sn/pij'. By DAVID PAGE, M.D., Kendal.--In I)ecem-
mount interest antd importance to all engaged in the practice of the hiahest ber and January IS74-5, a stiddlen oultbreak of citeric fever took place
branch of the profession, namely, prevenitive medicine, has beeni one in Staveley, a village of VWestmorland, midwvay betwixt Kendal anid
wnich seems to have dliviided the most distinguiished physicians into two Windermere. Twenty-five attacks and four deaths, the cases beinlg
parties,one section giving
ain affirmative, and the other a negative w'ell marked, and, with three exceptions, of a severe type, were re-
answer. Sir WVilliam Jenner, in an excellenit address delivered before corded in coniiiection w'ith the outbreak, wvhich, in its chief extenit, fell
the Clinical Society on January I2th, 1875, poinited out, wvhilst dis- with remarkable incidlenice upoin those houses dependent for their w-ater-
cussing the etiology of the fever, that the best mode of settling this supply upon a risvulet floNving through a portion of the village. Although
much debated query wvould be to study every isolated case occurring in subject to alnmost constant pollution from drainis anid gutters at various
out-of-the-w ay country places. Dr. Fox, as medical officer of health points above the houses referred to, the water of this bi-ook had beei
over the central, easterin, anid soutlthern portions of Essex,
had, with used with impunity for years. At the beginniiig of November, aii
this object in view, investigated thoroughly during the past two years elderly mani came from Kirkoswald, in Cumberland, where enteric fever
every isolated case in his district, many parts of which are only con- had recently prevailed, ill of the fever, and was laid ujp in one of a roy
nected with the outer wrorld by the most primitive methods of com- of seveii cottages situated hard by the edge of the brook, some 8oo
municationi. I-le recorded a summary of 27 isolated cases in this ex- yards higher up its course. lie died on January 9tl, and, dur-ing his
tensive area, which he has, in a sceptical frame of mind and animated illiiess, there was positive evidence of the discharges having been
with the sole desire of ascertaining the truth, carefully subjected to an throw'n into the stream. Between November 28th, the date of the next
exhaustive scrutiny. Of these 27 cases of enterie fever, three were case, and January 2ISt, out of forty-tw'o families who either habitually
or at times dranik the water, thirteen, or
clearly traceable to pre-existinig ones. Ile divided the reImaining 24
nearly one-tlhird, were attacked
into twvo classes-the doubtftul", and the decidedly untraceable'- with typhoid fever. Twvo incidents of peculiar value, from the clue
and placed i6 under the former, and 8 under the latter heading. The they afforded to the determination of the incubation-pelriod of typhoid
'doubtful" class comprised those respecting which there was a shadow fever -hen spread by means of a specifically conitaminated water, hap-
of a dotibt. Details were given of two of the most interesting of the pene(d in the progress of the outbreak. On Noveniber I4th, a girl,
eight "decidedly untraceable" cases, namely, the outbreaks of Asheld- whose pareiits resided in one of the houses by the edge of the streani,
haml- aind Langford. In the first, the apparent cause was excremental came home on a short visit from a farm-house in the valley of Longs-
pollution of water, an(l in the otlher an excremental pollution of air. leddale, seven miles aw-ay. She returnedl to the farm-house oni
The Langford ouitbreak was one of the most striking cases that had yet the eveniing of the following day, and, on December 2iid, was seized

beeni made public, showing the strongest probability of the development with typhoid fever exactly eighteen days afterwar(ds. I-erl brother at

of the fever from fxcal fermentation, all other possibilities of origin home iii Staveley w'as similarly seized on December gth. Both were
havina been elimiiinated. The arguments which had been employed by sever-e attacks. In the other instance, a pump, wlhicll had(l hitherto

both the parties of the controversy were examined and discussed, the been kept in working order, in spite of the intense frost of December,
reply of those believing in the spontaneous origin of the fever to the was frozen hard on the night of the 29th. The nearest pump was

principal argumenit of their opponents being considered unsatisfactory. I6o yar(ds distant, and several families resorted to the streaiii. Out of

The researches of Chauveau, Burdon Sanderson, Beale, Klein, Bastian, seveni who useci the water, four were attacked on Janiuary iotli, one oIn
and llallier, the theory of the omnipresence of typhoid germs, the the ith, andI one on the 12th. The lpump N-as thawe(l on January ist,
i

view's as to the dlisseminiationi of the disease by other articles of so that the use of the wvater was liiiiited to a coulile of days
food
* besides

besides milk, and the suspicion of a connection wvith the consumption which, in each instance, it ss'as averred that the supply hacl been takeni
of meat from fevered or diseased animals, were onily briefly alluded on one day only from the stream. Calculated from the (late earlier or
; to

the object of the author being to limit himself strictly to the point the later, the period of incubation in these six cases w^ould be from

raised by hiis question as presented to the lpublic lhealtlh plhysician in ten to fourteen days. The cessation of the outbreak was coimicideiut
w%oVrk in ruiral (listricts. The experience of Dr. Fox tenided to show-i. w\ith the alarm created by these nearly simultaIleous attacks, wlhicli le(
That enteric fever is sometimes spontaneously developed ; 2. That it to the abanldoimnent of the stream for the tiume, the case referrable
last

to the use of water from that source occurring oii January 2ISt.
slpreads by contagion in the overcrowded (lirty dwellings
'whilst it is rarely communicated from the sick to thehealthy
of the poor,
in three families only of the thirteen did multiple cases occtitr ; viz.,
In.

capacious,
airy houses wlhere cleaniliness in all things is the rule and 3. That the two, two cases respectively, and three cases in the third. Of the

immunity in the latter case is ascribable to the prevention of wvater, air, eighteeii cases directly traceable to the water-supply, thrce only w ere
and food pollution by the poison, and to the dilution of the poison, and adult males, the rest being wvomen and children. As the male poptula-
perhaps its destruction by the natural or artificial disinfectants, if the
tioni were chiefly employed in the bobbin-iiiills in the neighbourhood,
air be impregnated tlhereiwith. their immunity might be in part explicable by their greater absence from

T'A/5hodIv't'r1 in helsieof-.S'kie. B3yJAS. BRoWNT, L.R.C.P., Uig.- homne. Regarding the remaining seven cases of the twventy-five, thliee
The object of the paper was, wvithout entering into any description were solitary
cases. Onie vas that of wi-oiman
a had occasionially
who

the symptoms or treatmelnt of typlhoid fever in Skye, lo expose at least waited one of the other sufferers ; the other twvo lived
upon outside the

two evils, -which were asserte(l to be the causes of the frequent out- village, undler circumstamices wlhich excludedl any coniiection wvith local

breaks there. After showing that the outbrealks could not be attributed sanitary defects ; but both hiadl been in the liabit of frequentinii the vil-

to bad
watcr, since the water in Skye N-as excellent, the author asserted lage, and might in that way have contracted the infectioni, although
the two chief causes to be: i. The almost universalhabit among was iiiipossible to trace its origin in this dilrectioni. The
other fouir
crofters of lodging their cattle tinder the same roof as themselves 2. cases occturred in the farm-house in Loiigsledldale, to which the fever

The scaintiiness of sleeping acconmmo(lation, large families being crowded had bieen brought by the girl whose case was mentioned. cases The

into two, and sometimes one, apartmient. Besides these evils, there
is'ere severe two childlren anil two adult-s were attacked, tw'o of the

cases eiidiiig fatally. There w-ere no local cir-ctuiistanices whiclh coul(d

-was the lpractice
of keeping piles of manure in fi-ont of the
loors, antl having peat-fires in the centre of the room, with no
cottage-

means in the remotest manner account for the spread of the fev er, inasmnuch
of egress for the smoke sav e the dloor and wvindmow, and a small hole as the w-ater w-as derived from a spring isstuing flom the rocky hiill-side
the roof. The dlifficuilty' of remedy was the tenacity of the islanders ahove the houise, aiid there wvas strong evidenice to show that maiiier the

old customIll.
TI'he remedly suggested wvas to remlove the and cattle, of iiifectioni was by the actual swvallosving of solid particles excreta. of

locge them outsi(le, by which ani adlditional apartmnent wvould be at onice In conclumsioii, the author citetd several exaamples of the occurremice
available for the accominmodlationi of the famiill. In miost of the
typihoid fever uiitler conmitions whiicli illustrateI the tdifficulties thle iii

of typhoid fever, tend(lenicy to relapse

a observed, whiclh
as was way of miiaking sure that the negative evitdelice upOlii which luestion the

atti ibuted to the conistanit pies -ence of the exciting catise-imnpuire atmo- of the sponitaneous origin of the fever niecessarily deependledl coiii- as

splhere. The lungs wvere frequienitly attacke(d in these relapse, cases of lete evidleiice, and without prejudice to either si(le olfered a contribu-
anid great discomfort wvas, of coutrse, occasioned by the foul tioln of facts to tIme etiology of the disease. i. W"ater polluted with
sphere. Again, owing to scantiness of accommodation (in evidence of excreiiieiitalmatters had beeni used w'ith imiinuniity for years. This 2.

whlichl the remarks of Lor(d Young in the late Snizort case at Inverness
wvater, the additioii of the dejections of a typhoid patient,became
oii

vere ackldLced), isolation wxas impossihle, and the fever coulld be not the car-rier of the contagion. 3. The incubation-period not is

conifinied to only one or twN-o miiember-s of the family. The paper sarily shortened, but may even be of prolongedduratiomi, equally in

cltid(led hy(leclaiiiig the r-eadiiness of the proprietors to afford every

spreadi oftypphoid fever by the agency ofwrater as of air.-Dr. BRITTON
(Halifax), from numerous cases that
facility for the erection of separate dwellinas for the cattle. The remedy had occurred in his neighbour-
wvould be inexpensive, owing to the abundance of stone, the only hood,had come to be of opinion that enteric fever might arise
spon-
siderable expense being the roofing of the houses. taneously.-Dr. CARPENT'ER (Croydon) said they wanted more
 AuguSt 28, i875-1
Auus
28 85]TEBIIHMDCL7UAL
TIIE BRII-ISH MEDICAL _70URAA'L. 267
6

before they could determine as to the spontaneous or non-spontaneous measles increased to 376, and from scarlet fever to 147, in each i,ooo
origin of typhoid fever. Some time ago, he had a large number of deaths from these diseases. Up to five -ears of age, thle miiortality
cases, the sources of which he was unable to find, and he then came to from small-pox remained about the same in each year of life, whilst
the conclusion that they had arisen suie spontte, although that scarcely that from measles much increased, and that from scarlet fever in-
represented the state of his mind at the present time. The germs of creased in the third year to I65 per I,000, and then decreased to 120
disease might have lain dormant for many years in the situations wNhere in the fifth year. The proportions of deaths from these diseases during
they were placed. Ile remembered a practitioner in Oban informing the first five years of life were as follows: from small-pox, 350; from
himi of some such cases occurring in Mull. A proprietor of that island measles, 920; and from scarlet fever, 646; whilst from all causes the rate
ordered the removal of some ol0( houses wvhich ha(l lain in a state of wvas 407 in each I,OOO deaths. Above five years, there were, therefore,
ruin and uininhabited for many years. Eight men were employed in 65o deaths from small-pox, only 8o from measles, and 454 from scarlet
digging the walls, and every one was attacked with small-pox, the fever, per i,ooo at all ages. This remarkable difference was attri-
germs of that disease lhavinig lain in these houses all those years. Now, butable, in Dr. Tripe's opinion, to vaccination affording but an imper-
if the germs of small-pox lhad lain dormant for many years, why not fect protection against an attack at later periods of life, as compared
those of typhoid fever? As to the incubation of typhoid, he knew with ani attack of the disease itself. Dr. Tripe thought, however, that
that in the Croydon- outbreakl it varied from five days to over two even if an individual should not have had any of these diseases, he be-
montlhs. That outbreakl in Croydon, during which there were 500 came less susceptible to infection as age increased; and that this dimi-
cases, he lad traced to the effects of an intermittent supply of water nishedl susceptibility occurred very early in life as regards measles,
coming after a constant supply. A hydrostatic vacuum was thus later on (above 15) as regards scarlet fever, whilst it did nlot take place
caused, and all the noxious gases from the surrounding soil wvere ab- for small-pox uiitil about 40 years of age. The extraordinarily small
sorbed by infiltration.-I)r. Ross (Lon(lon) ascribed much of the typhoid proportion of deatlhs above 5 years from measles, above I5 from scarla-
in large towvns to emllaniatiolns from cow-houses, cesspools, and wvalls tina, and above 45 from small-pox, formed the data on which this
soaked in sewage wlhiclh hadl escaped from broken drains or overflow- opinion was founded.
pilpes.-Dr. MARSHALL (Greenock) said that one cause of enteric fever Ont sosnie Pointfs connetefedelfit/ Cotfage ZZospsitfls. By JAMIES COOPER,
had, he thought, beeni overlooked. In certain states of health, the F. R. C. S. Ed., Cromer.-The following questions wvere discussed in
eniteric systemii of the patient itself created poisons which might poison this paper. Are cottage hospitals likely to injure the old establishe(c
the patient. Gases or germs might be germinated in the body in cer- hospitals ? To what extent should they be self-supporting ? In what
taiii states of health from the lowv state of digestion, anid a sudlden ex- w^Nay should they be provided w,ith medical attendance? Should medi-
posure to cold might set this poison-manufactory agoing.-Mr. cal men give their services gratuitously?
STEPHEN ALFORD (Lonidon) said that, in the high parts of London,
typhoid fever was constantly sent up the drains from the low districts, T/inrsday, A4ntnst 5tf/.
the flowr of water downiwards driving the noxious gases upwards. The
question of trapping drains thoroughly wvas a much more important GRouP B. MIEDICAL LEGISLATION: MEl1EOROLOGY ANi)D DISEASE',
one than the spontaneity or non-spontaneity of enteric fever.-Dr. A. STATISTICS, ETC.
P. STENVART (London) said that it wvas a curious fact that many of Pi-esi'cnif'ts Address.-The President, the Right Hon. LYON PLAY-
the most destructive epidemics of typlhoid that had occurred hadl not rAIR, M.P., dlelivered an address, which was published at page 173 of
arisen in crowded cities, but in rural districts, where there was pure air the JOURNAL for August 7th.
and seemingly plenty of pure water. He narrated the case of a friend Oiz tfeicecessity of Legislafioui for fiie Confrol aitdl ['reatftentf oa
of his, who wvent to inspect a boarding-school previously to sending his Insante Driinkers. By A. PEDDIE, MA.D., Edinburgh. [See p. 253.]
two daughters thither. Eveiything he liked well, but the drain, which Ont fiie Conttfrol andl Aesf;-aint of Hlabiftnal Drua/ca-rs. By G. F.
passed within three feet and a half of the well. When he spoke of BODINGTON, MI.D., Kingswinford. [See p. 255.]
this, he wvas informed that the water of the well had been drunk for Sir RoB0ERT CHRISTISON, after thanking Dr. Peddie and Dr. Bod-
years, an(I that no disease had ever occurred. To satisfy himself, he ingtoii for their papers, saidl he de,ired to submit a resolution. A
twice had samples of the wrater taken and analysed, and it was found well consi(leredl resolution on this subject, brougyht forward under thc
to be perfectly pure. He sent his dauglhters to the sclhool ; but, in tw o auspices of the Association, ought to have great weight. Therefore
or three w eeks, typhoid fever broke out, anid of four deaths which oc- they should be careful what they said, but at the same time very re-
curred one w,vas that of his youngest daughter. The water of the well solved to carry it out. He moved:
was then found to be putrid from the sewage whiclh had found its way "That excessive intemperance is in many cases a symptom of a
into it.-Mr. BARTLETT (Londoni) mentioned that he had analysed the special form of insanity, which requires special treatment, wvith a view,
water in hiis house nine times before he found a trace of contamina- first, to the recovery of those affected, and, second, to the protectioni
tion; and this contamination had been caused by what Dr. Carpenter anid advantagre of them and of society. That in the present state of
had pointed out: the hydrostatic vacuium, resultinig from an intermittent the law such treatment is not attainable, an-d that it is desirable that
supply, drawing in noxious gases.-The PRESIDENr, in bringing the legal provision slould be made to render it attainable."
discussioni to a close, referred to the interesting and important nature of The subject, he said, w,vas one which occupied his attention at a
the stubject. However different opinions might be held as to the very early stage of his professional career, in consequence of hlis oc-
spontanieous origin of enteric fever, there was one thing they could ctupying the Clhair of -Medical Jurisprudence for ten years. At that
all practically do, wlhetlher as medical officers of lhealth or in private time he livecl witlh hiis brother, wvho was a member of the Scotch bar.
practice ; viz., war againist filth in all its forms. By taking as a text, in At their common table, he usecl to meet several of the most eminent
their broadest sense, the words of the prophet, " Wash and be clean'", members of the Scotclh bar, anid there wvas not one of these gentlemeni
they could do a great deal to prevent the spread of enteric fever and who did not scout the idea of putting habitual dIrunkardls undler re-
all other kinds of infectious diseases. straint. What they uroedl was, that they could not distinguish be-
An Oaf/fis-eak of Enfte-ic 1ever in tf/e Village of A'iYlalalmarsh, Derb)y- tween a habitual drunkard who was suffering fiom disease and one
s/tire. By A. MACKINTOSH, M.D., Chesterfield. -Dr. AMackintosh wNho was suffering from the effects of vice. But in course of time several
sketched the geograplhical and geolog,ical features, and the sanitary con- of these gentlemen came to see instances of habitual drunkenness in
ditions of the locality, and(l then gave a history of the outbreak. I-le relativ es and friendls. Gradually conviction stole UpOli them ; audlhe
believed it to have arisen de ntova through drenching sewage-water and believed that now, among Scotclh law^yers generally, there was a feel-
inhaling sewage-emanations. He coul(d not observe evidence of con- ing that some sort of restraint should be placedi oni habitual drunkardls.
tagion in any case. 0/ Recently he had charge, along wvith Dr. Peddlie, of the representationi
On tfhe lP ojapgafticn IYjph/its Abdolninalis. By EDWVARD WATE1 RS, which was being got up by Mrs. Dalrymple for presentation to thc
M. D., Clhester. Home Secretary, and in the course of a day and a-lhalf lhe got that docu-
On f/ie Ages at Deatf/ fraoz Sz(all-pox, Alleasles, anzld Scar/(o inii(l. By J. ment signedi by the professors of Metaphysics, of MIoral P'hiilosoplhy, of
WV. TRIPE, Mi.D., London.-The calculations were maade from 2,5I6,468 Political Economy, and, what he considered of more consequence thlani
deaths from all causes in England durinig the five years i868-72, and all these, the professor of Scotch Law-[/husir, ea(zr, an(d op/batse]-andI
embraced 48,435 deathls from small-pox, 47,34i deaths from measles, not only by him, but by a former Solicitor-General for Scotland, nowv
an1d 112,4I2 deaths from scarlatina. The deaths were given for every Dean of the Faculty of Advocates. [A4pploase. ] A great (leal haad been
year of life under 5 ; theni for 5-i5 years, 15-25, 25-45, 45-65, and 65 said in print and in the papers as to the dliffictulty of dlistinguishing be-
and above. Dr. Tripe showved that, out of each I,OOO (leaths from tween habitual dlrunkenness the result of vice, aiwl habittual drunkenness
these diseases, 149 occurred from small-pox, 200 from measles, 65 the result of disease. IIe suspected they must acknowvledge that this
from scarlet fever, during the first year of life; that, in the second year unfortunate condition was not very often purely the result of disease.
of life, the mortality from small-pox decreased to 53, whilst that from He had seen it so, but by far the greater number of cases arose in
 268 THE BRITISH MEDICAL _OURANL. [August 28, I875.
consequence of the persons having gradually yielded to the vice. They Dr. JOSEPHI RoGERs (London) said it continually happened that per-
must consequently face this fact-not try to evade it-anid show the soIns were sent to the poorhouses in England, Ireland, and Scotland,
Government and(l the Legislature that the cases in the end were not who were suffering simply from the effects of drink. After a few days
different--that there was no difference in their features and in the re- they recovered, and as soon as they were able to craxvl over the door
sulIts to the drunkards themseles, to their families, and to society at they demanded and got their liberty. Hle thought poxver slhould li
large. hYlien, in the little society to which he had alluided, lhe was asked, given to enable the auLthorities to detain such habitual inebriates. Ile
Ilow arc you to disting-uish between moderate excess anid such ex- tlhought that there wvere too maniy brewers ancd publicans in the hlouse
cess as you consider bordering on insanity?" hiis reply was, that he was of Commons. [A/p/lase.] That vas the true explanation xvhy lno
always very cautious about giving definitions. He was onice asked in proper redress could be got from the present Parliament,
the witness-box to give a definitioni of insanity or unsoundness of minld. Dr. J. C. REID (Newbiggin) said that one of the evils of the Scotclh
lie knewv vcry wrell that this was but the introduction to a dexterolis Lunacy Act of I843 was to do awvay with the poxver wvhiclh the Scotch
cross-examiination, andl lhe replied that that was a problemn on wvhicl had possessedi from time immemorial of seniling their dlrunkards to
tw-elve jlLdges in Engrland lhad exercised their ingenuity and had failed; one of the islands in Loch Lonmondl. [lke;, ha,ir.] All the talk as to
that mn,any menl had written on the subject and failed- that, there- the restrainit of drunkarlds interfering wlith the liberty of the subject
fore, it was not to be expected that he should succeed * but that, if wvas balderdash. The liberty of the subject was interfered with from
counsel would briing a case before him, he should not only satisfv tlte date of his birth. [Leau,the;-.] Onle coul(d not be born blut ani Act
himiiself, but satisfy his questioner, whether it wTas a case of insanity. of Parliament stepped in and said he must be registered; then he must
[Leau/zter- n(d q(/ploeo.] Ilis reply to the doubters on the question be vaccinated ly order of Parliament ; and xvheii lhe grev oldler, and
under discussion was the same: BE-ing before me a case, and(l I wvill tell vanted to take a sleepina partnier into the concern, he couldI not lie
you whetlher it is to be accounited for by dlisease or niot. He w,vas rather mnainred in England after twelve o'clock. [LanAhe;i-.] What xvas
inclined to borrow a name from the pure English, an(d call this (drink- worse still, he couldi not lie decently laid away in his coffin without
crav7ing; that -was the real essence of the thing-the mnan hadl such a ani Act of Parliament iiiterferiing witlh the liberty of the subject. But
craving for drinik that hie could not resist it. It would, lie dared the law was too leniient, ati(I woul(d not interfere wvith the liberty of the
say, le often difficuilt to distinguislh, but they could always deci(le on subject whlo wxas an enemy to hiiiiself, to his family, and the public wveal.
examination. [I/er, hcjr.] Then, if they did. make a blunder, and [i/ar;-, hee;-.] I-le holped the time wvas not fair distant when the law in
initroduce among(1drink-cravers a mani wlho was inot so bad, was aily regard to chemists and doctors would bh madle to apply to publicanis.
harm done to 11im ? No, but a great advantage, for they took him in If a chemist soldl poisoir an(d a person diedl, lie wvas lheld responsible
timie ; nio harm was donie to his frienids, whom lhe was ruiniing, and no aitdc if a surgeon made a mnistake, he wias hekld liable in ntn actioni for
har-m to thle puiblic: in fact, it wi-as onie of the extraordinary cases malpractice. WV,hy should the publicaii be freed from the same liabi-
whliere an error could do no hiarmii. [I/ear(, la-ar, and lHatiee;] le lity? AMake the pulilicans responsible, and there would be far fewer
hoped the Association would adopt the resoltution, anld go forward to unhappy homnes. [A/p laese.]
the Legislature. They had a righteous cause ; and, in his longc expe- Mr. LIDDLE-I (Loindon) believed the love of strong drink was enlgeni-
rience, there never hal been aniy riaht thingr, notwithstanding all diffi- dered vely muclt among certain classes by the miserable conidition of
culties at first, that as niot eventually carried in the House of Com-
w their dwellings and by over-crowding.
monis if they could get some zealous im-ember to brimmg it forward. [Ap- Dr. A. P. STEWNVRT (London) saicl great harm wvas done by the
statements made in regard to the identity of aiabitual dlrnkenness and
iMIr. 11UBAN--- ) (Vork) seconded the resolution. As mnedical men, disease. If they wvent before Parliament on the grouitdl that it xvas a
they did niot reqtire to be satisfied that there were such persons as disease, they took uo lierilous ground iiideed. If they said a man was
habitual drunkards, but the public mind and the Legislature required a maniac, they wvould be toldl to send him to a lunatic asylum; and if
to lie educated oni the point. There was no one whlo hadl had large they di(l tlhat, miiore harmli Nvouldi be done thamn good. He approved of
opportunities of plractice lut must have felt this to be one of the greatest Sir Robert Christison's proposal to invent a nexv name. For liearly
difficulties of hiis professional life, and more especially wlhen wvomen thlree litindred years the pow er, originally givelt by James 1, had existed
were the subjects of the vice. lie never knewv ani intelligent medi- of intemfering with thle liberty of the suibject because he vas drunk
cal miian who h1ad aniy doubt as to the propriety of placii<g such people that vas, the magistrate imprisoned a mait for a day or two for being
ulider restrainit. Ile hoped that oni some iniember of the IIouse of drutmik. Let the principle be extctedledl to continued restraimit, and they
Commons the il-antle of IMr. Dalrymple wtouild fall, and that a proper wx ould touchl the evil.
ieasuire wvould cre long pass. [Ap./letuse.] The Council of the Asso- Dr. CAmtm11'NTEFR (Croydon), in reference to time committee appointed
ciation were, he said, taking steps in the matter, and at niext annual by the Council of the Associatiomi to report on tlte subject, said that
mectiiLg2 it was hoped. they would presenit a full repolrt. [As/f lanse.] Comimittee would be gladl to get all the iniforntationl possible, and lie
Dr. MORRIS (Baltimore), as a trmistee of an inistitution for receiving lhoped imienmbers ivould send in all they coutll.
iniebriates in America, saicd Americans were ndot a peolile whlo wvould Tihe PitisiIsN 1 said lie lild actedl omi the Coimniiittee tipOii Habittual
bear restraint very cll, and it might be stupposed that tlhcy would be Druuikards iv-ith hiis friend Mir. Dalrymiple. lIe emitered the Committee
the last in the world to submit to a law' of this kind. But in several in ani extremiely doubtful state of mind, his feelimng being hostile to the
States there \ere sulch laws for the restrainit of drun1kards-lavs alipa- pi-op.isal; and this he had told M1r. Dalrymple. Ile theii thouglht tlley
rently stringent, lint not actually so in olecration. When any mnan or must look chiefly to cdtucatiomi auid diffusiont of kntow ledge amimomig the
head of a family was knownci as a habitual drunkard, anid aniy two re- pcople as t'le means of preventing dlruiikeness, and that restraint wvas
spectable householders wvent before a jutdge andl declared tlhat, the man a 'very qtuestionable mocle of procedure. liut le confessed that
was committed to the ineliriate asylum, as it was called, and kept there the evidlelice brougaht forward lecd him to a dhifferent conclusiomi
for a certain teri genoer-allv a year. The vcry fact of tlhe existence before the labours of tihe Committee -xwere closed, and lie signe(d the
of the law wvas a (leterrent to drinkers. IIe would say, I)o not let reliort a(lvocating cer-taiii formiis of restraint as beiiig miecessary in the
this liuglbar of restraint of personal libertvy have anyv wveight wA-itlh YoI, case of habitual dlruiikardls. It ivas because the public were not suffi-
for we Americans, who I,now what liberty is, or at least think e do, ciently educatcel on this mnatter, an(ibecause they had not shown suffi-
w

(1o not find that it interfcres with us. [i/p/lmse.] The instittution to cient imiterest in it, that the Ilouse of Comiinoims wvas unable at preseiit
which he refer-red tookl in three kinds of inmates: first, those who paid to legislate. The Associatioii w-ould do great good by the resolution it
nothing ; second, those w%ho paid a modlerate sum, sulch as w%orking might adlopt, but that xas liot sufficiemit. lhe members must educate
classes cotldl afford, fiom ISs. to 25s. a week ; theni the educated and the public, amid the House of Comtmonis must feel that it wvould be sup-
-avealthier classes, whllo pail a fair plrice. Thl original instituLtioni was por-edl liy the pumldic ini legislating omi the stubject. The liresent miiind
too niear the city, and patienrts frequen-tly strolled tlhitlher ancd got sIririts. of the Houise of Commnons xx-as, tlhat therle rere great diffictilties con-
Now thiey had boulght a farmil five mlliles fiom town, and they intended liecte(I ith. tllc subject, and tlmat tlhcy must loolk these (difficuilties in the
to blilld a newr instituttioni on the cottage system, and to classify thle face. But lie ,vas afraid the Ihouse xvas like the Higlhlamnd clergymnami
natcs Tlie institutiton wvorked admirahly ; it wNvas not self-s-upport- of xxlhon, Dr. Normami MIacleo(d uised to tell, xvlho Said that, wheniever
in-) bIit they -ot a sm1all contribiuition fiouti tlihe Statc and stiliscriptions lie sa-w a difficulty, lie looked it fully in the face, andi then passedl by
fli
on toiie public. 'Tlhi)e cotuld
not ntalkc ani absoOlutte cure ulnder twoomi the other side. [laZ' it;.] If, hotvever, the public took up the
years, for it requirecl that timlle beforc the imlolecular structure of the questiomi for tliemisselves, the House of Comit-ions, finding public feeling
br.i;i tisstlo, destrioyed by habitual drinking, was entirelyreconistruicted. supportiig themmi, ouil soonl pass a measimre. [z-lp/lease.]
'l eylhia(l thirty-tlirec per ceint. of cures, anid when a reconstructed and Thle resoluition xvas theii carriedl by acclamation.
rebulIt clerl or merchant left the inlstitutioln and xw eut aliout amongst State Melicine ,'i tlatioto Edutcatiot. By HENRY J. YELD, M. D.,
hiis fiiends, the merclhants pul their hanids in thleir pockets and paid Sunderland.-In his introductory remarks, Dr. Yeld pointed out that
for tb-at reconlstructioln by subscriptions. the legislation of recent years has placed tlie cliildremi of the ix-orking
 'August 28, 1875.] THE BRITiSH MfEDICAL 7OURNAL. 269
classes in a much better position, as to the sanitary and other conditions the poor relief expenditure w'as /52,455, or /22,000 more, Ile also
under which their education is carried out, than those of the middle gave the following tables as showiuig contrasts.
classes, and affirmed tlhat, in the matter of education, there has been Relief. Gross Relief.
class legislation, an(l niot legislation for the general welfare of the com- Poptilation. Medical

Xs. d.
munity. The object of this paper was to bring prominently before the Glasgow 1..
*70, 553 2, 377 0 0 40,875 0 0
public the unsaniitary and otlher cond itions utnder hich many thousands Iiarory ......... 234,115 2,057 0 0 43,623 13 2
of the chliilren of the middle classes and upper sectioni of the lowN-er I)undee 86,527 564 12
14,971 8 3'
classes are educated. For this purpose, he first stated what may be .1-ewsy. ...... 72,079 2,100 0 0 8,267 0 0
considere(d as the necessary requirements for healtlhy anid efficient educa- AnX/s,oh ............ 72,384 1,638 0 0 6,489 0 0
tion: I. The school buildings should be perfect in their sanlitary arrange- Greeniock; . ........ 59,795 72I 19 4 9,698 o o
ments, alnd in every otlher respect; 2. TEducation should be physical as IJonrlondt ert ir........ 58,758 I,910 0 0
4,747 0 0
well as moral and mental 3. To ml-eet this reqjuirement, a playground Aberdeen..... 47,077 246 6 Io 12,512 i6 o
should he attaclhed to every sclool ; 4. Person,s engaged in tuiition Ditnla-anon ...... 45,990 I,069 0 0 4,587 0 0
should possess a certificate of their comipetenc) to act as teacliers, anid
slhould have some knowledge of the laws of healtl. After a fewi- remarks The author nICxt in1quireCl wh-lethier
anly proof cotdid
be adduce(d show-
upon each of these points, ie piroceedci to shiow to what extent the ing the benefits arisilsn
froiwi finidinig
the iwedicines and a reason- paying
schools niowr existing, tlhrouLglhout the country, for the educationi of the ably faLir stilpend
for services. B3onhill,
Dnmbaiton, hias a population
children of the midcdle classes, fail to meet these requiremen-ts, taking of 9,408 ; the medical officer a of /78 I9 :7; all medi-
gets stipend
the hunciidhed priivate schools in the borougli of Suiider land by wXay cities are foulnd. The poor relief amounts to /1,597. In the adjacent
of illustration. (Oi inispection, only twelve of the hutindred w%vere parish of Car-dross the populationi is 7,OS0 ; /46 8 2 only is paid for
schools specially built for the purpose of education, the remiiainder being medical relief, ouLt of which medlicinies hasve to be found ; the poor-rate
rooms in d\welliii-houses used as school-rooms ; tllirty schools w%\ere amiiounits to /1,390, or olnly /200 less than in lollhill wVith. 2,328 milore
overcrowded and( defective in their sanitary ar-ranigements ; while, with people. In Cadclross, last year, the poor relief lad risen u) to
regard to their ventilation, in go per ceit. the onily me-ans of ventilation /I,469, neaarly /ioo in excess of Bonhill, medical relief remaininig as
wvas by the wvindows, alnd in miiost instanices by a single window, there before. As an instance of great disparity in paymeints for services,
being iio special meanis provided -whereby the air might be kept pire. he quotedl Old anid New Deer, Aberdeenshire. Newv Dcer hiad a popui-
To several schools there was no water-closet or other accommodation lation in I871 of 4,853, of w-liich nntimher I52 wN-ere registered poor anid
attached, anid only five sclhools lhad playgrounds adljoining. Lastly, their (lepecldenits, an-d 50 were casual poor and their dependents, total
Nvith a viewv of placing- these schools oni a more satisfactory basis, and 202, wVit 7 luniatics. Medlical relief cost /30, medlicinies being founid
more in accordance wvith the spirit of the age, he proposed that anl act by the medical officer; the total gross relief amounited to /803 9 2. : :

of Parliament be passed or order in Council (if sufficient) be issued,
providing: i. For the registration of all persons acting as teachers
thlroughout the country ; anid that, from and( after a fixed dlate, no per-
son be registered w itlhout producing a certificate of competency from an
e(lucationial examiniing 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 aulthority. 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 piro-
posed to be registered are in every way adapted for the purpose of
education. 4. That the numiiiiber of children allowed to be educated in
suchl school shall be fixed by the local authority. 5. Tl hat the medical
officer of health, or otlher officer of the local authority, shall have power
to inispect such schools, from timie to time, at any lhour betw-een 9 A. at. andl
5 I'. At. 6. That wvitl a viesv of encouraging the erection of efficient
schools, the Privy Counicil shall have loNver to make grants of money
towards the erection of such sclhools on such conditions as may be
determined upon.
Tize A nona/klis aong]tLDfic')ncies of Pa)-ochiaZ lAlecicrdl RceZ?ytj in SCo/-
landl. By Jos1iu.ii ROGERS, M. I)., Londoni.-Dr. Rogers began by re-
manrking tlhat, in I869, a Select Comr-mittee of the House of Commons
was appointed for the purpose of inquirinig into the working of the
Scotclh Poor-laws. This Comnmittee, of wlviclh Mr. Crawford w%vas chair-
man, collected during that year ancd the following a voluminous mass
of evidence. In the year i87I they agreed uipon their report, and in
the following year Mr. Crawford brought in a bill, which was based
uponi the Committee's report, but was, however, lost upon the second
reaching. Since the iejection of the Bill, no steps had been taken to
remledy the evils that wvere shown to exist ; and, as an amendmiient of
the system of medlical relief was embraced in that Bill, it occurred to
him that he might revive the subject. After giving a sketch of tlle sys-
tems of Poor-lawr me(lical relief in Englanid and Ireland, he pointed
Of this number of paupers 7 eitlher died or wvere otherw ise got rid of
in the coulrse of the year. Old Deer has a population of 5,oS5; there
were 257 registered poor anid dependents, 94 casual poor and de-
pendents, anld 24 lunatics: of this nuimber 30 dlied or otherwvise disap-
peared ; the total poor relief was /i,624: IO: 7. Although the popu-
lation, pauperism, gross relief, sickiiess, and iwortality, wvas so much
greater than in New Deer, the stipend out of wlhich everything had to
be found wvas only /9 : Io : I miiore than in New Deer. He would ask,
wrhat clhance does there exist that the sick poor in Scotland get propier
medicines when they have to be supplied from such stipeiids? 'Thie
system of medical relief in Scotland had a deteriorating moral effect on
all connected wvitl it. Referring to the enormous extent of some of the
rural districts, hc remarked that the whole of Sutherlandshire, with an
area of i866 square miles, and a population of 26,ooo, is divided into
five medical dlistricts- Assynt, Eddrachillis, Golspie, HIelmsdale, and
ongue, including several minor parishes. The district of the mwedical
officer of Assynt extend(led I4 miles in one direction, and 28 in the
other. The whole sUlll paid for imedical relief in this couiity amounts
to /5o5, out of which horses and drugs have to be founld. He could
not give imuch information as to the interior arrangements of the
vat ions poorhouse hospitals ; but if the description given of Barlohill
Poorlhouse, Baroiiy-in a very able and evidently truthfuLl report, for-
war-de(d to the hlouse Comiwiittee by the medical officer-w-ere typical
of their general condition as receptacles for sickl people, it was clear
that there existed as great a tiecessity for a swveepiiig alteration in their
arrangements, as lie hacd shown to be necessary in the treatment of the
out-door sick.
Mr. ERNEST IHART (London) moved:
"That in the opiliIon
of this Section the initerests of the sick poor of
Scotlanld would be furthered alnd the systeni of poor-lawv medical relief
wvould be placed on a more satisfactory footing, if the following measures
of reform wvere adopted univ'ersally througlhout Scotlanld-viz.,
that the

out that in I873 the gr-oss poor relief in Irelanid amounted to /927,730, cost of imiedicines be supplied by every Parochial Board, excluisive ol
or 3s. 534d. per hiea(d of populatioli, althoughi that sum inlcluded an the salar-y of the medical officer ; that medical officers be remov'alble
olutlay of /155,362 spelnt Oll medical relief ; this latter amount conlsti- from office by the Board of Supervision only; that the Parochial Boar(ds
tuting the sixth part of the total outlay, fo- a population of 5,344, 151 be required to superannuate sucsi medical officers at the proper time;
shilst in the sane year tlhere was expen(led onthe poor in Scotland and that the Parliamentary grant in aid of medical relief be place(d o01
/873,075 for a population of 3,360,o68, or 5s. 2'4d. perhlead of popu- the same footinig as in Euigiandl an(d Wales. That this resolutiomi he
lation, of which sunm onlly /34,000 was expended on medical relief, or reported by the Clhairmaui of this Sectioii to the geiieral meeting of dile
in round niumbers abouit the twventy-sixtth part, againist the sixth part ex- Association; aidtI that the aid of the Association amid of the Scottisl
pended in Irelanldl. Of this sum of /155,362 spent onl me(lical relief Braticlies imi particular be requested
in support of aim effort to give legis-

in Ireland, /24,279 w'elnt for meclicinies anid medical appliances: if a
propoi-tioinate sum were expended in Scotland, the outlay for uwedicinies
alone would cost the parochial medical officers /15,264. To make the
matter imore clear, he contrasted certain Irish with certain Scotch towns.
B3elfast has a population of 202,641 ; the medical relief ill 1873 cost
/4,078; gross relief aiwiounted 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
lative effect to the above recomnwendations."
Nearly all the defects pointed out in the Scotch Poor-law' had, lie
saidc, beeni removed in Irelanid and Emigland; and althouoh, on the sur-
face, such a measure appeared to involve greater expeniditure, imn the
long run it proiwoted economiiy in health, life, and mouiey.
Dr. A. P'. STxXEVRT (Lolidlomi) seconded the resolutiomn, which, after
some remarks from variotus Scotchi Poor-lawnmedical officers condemmii-
ing the piresent system, wi-as a(lopted uuianitwously.
 270 THE BRITISH MEDICAL ?OVRNAL.
O n, t/1 .Sleadliness of /7t rilot/ions bet/swn [ /etzther (i;t(l .3lor/oli/y in
Lontiob. By ARIrlUR MITCHELL, M.D., F.R.S.E., Edinburgh.-
The object wNfas to shliow that the distribution of deaths from many of
the particular causes of death over the different wveeks of the year, as
deduced frolmi the recordcs of a lonig series of years, was substantially the
same as that for eaclh (quinqutuennial period, or for each single year, comi-
posinig the long se1lies. This was shown to be true even of epidemiiic
diseases like smiall-pox anid scarlet-fever. It was fuLrther showni that
suclh (livergences as occurre(d in the distributioni of the (leaths over tlle
weeks of the year, between onie year anid aniother, or one period of
years and another, answered to corresponding divergencies in weather.
Deatlhs from diarrhcea, which were greatly under seasonal influence, were
used to illustrate this. The general conicltusioni was, that the relation of
deaths froimi niany diseases to wveather was so stea(ly as to conlstitute a
feature in their natural history.
The ltDlnenct 't f 11('eoh//u',' t/1w Deoa/h-rol/ ftom
oil D
sleas'ss
on](l at dYte;e/nt zl'-cs int lonedon in 1T-e'ni-fo r;- Laise' 'owT;Jns
of G)rL'o/IIriiin lirelm(li. By ALEx. BucIit.N, A.M., F.R.S.E.,
Edinburglh.-This paper wvas 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. Tlhe
results for all the large towns showv duriiug the winter moniths an excess
above the average miortality. As regards the Eniglish towns, the excess is
greatest at Norwich, Wolverhampton, anid Nottingham; and least at
Bradforld, Leedls, Salford, anid most other towns in the north. In Scot-
land, the winter excess is greatest at Aberdeen, and least at Leith anld
Greelnock. At Duibliln, the largest monthly mortality, 22 per cenit.
above the weekly average, occurs during February and 'March, being
from a montlh to six weeks later than the time of the maximum of the
English and Scottislh towns. In all the Eniglislh towns, the minimum
mortality of tlse year is in the spring months, the amounts below the
averages of each town being greatest at Norwich, Wolverhampton,
Birmiingham, Leicester, and Nottingham. In Scotland, on the other
hanid, autumn is the healtlhiest season. In Glasgow and Edinburgh
the deaths fall about 20 per cent. below the average in the month of
September. Durinig the period of higlh temperature in summer, every
one of the larae towns of England shows an excess of deaths above the
average, with the sinigle 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
veeks hich indicate the highest mortality, the excess per cent. above
[August 28, 1875.
Norwvich, 5.02; Newcastle, 4.6I; Bradford, 4.42; Wolverhampton,
4.03; Sunderland, 3.89; Lonidon, 3.45; Portsmouth, 2.94; and Bristol,
2.38; in &SCo//oln: Dtundee, 2.14; Glasgow, I.90; Greenock, 1.75;
Paisley, 1.7I ; Leith, I.45; Edinburgh, I.23; Perth, i.o8; and Aber-
deen, o. 96. The summer temperature of the Scottish large towns is
several degrees lower than that of the English towns, and we see that
every olne of the Scottish towns has a mortality from diarrhcea lower
than the lowest mortality of any one of the English townls. The diar-
rhwa imortality of eaclh town is foulnd from year to year to rise propor-
tionally witlh the increase of tenmperature, but the rate of increase differs
very greatly in different towvns. This points to other causes than mere
weather, as determininig the absolute mortality ; and it is the investi-
gationi of these causes, which may arise from topographical, social, or
sanitary coniditions, peculiar to eaclh town, whiclh calls for instant and
most serious attenition. In order to work out the problem of the rela-
tion of the weather anid mortality of our large towns, it is indispenisable
for the comparisoni of the different towns with eaclh other, that the
systemn of meteorological observation be uniform at all places, parti-
cularly as regards the lhours and modes of observing the temperature,
humidity, an(d movements of the air, and rainfall; and it is fturther in-
dispensable that several meteorological stations be established in each1
of the larg-e towns.
On Dent//s by Accident in th//e 21Anvy and Artm)y. By Inspector-
General WrAi. R. E. SAMART, C.B., MI.D., lIaslar.-The collation of
statistics through thirteen years showed, that these stand as 3 in the
navy and i in the army against .707 in the metropolis per I,OOO. The
admission for treatment from all causes amounts to 1 32. 9 per I,000 in the
navy against I 14.3 in the army; the excess in the former beilng made up
of hurts, which stand as 29.5 in navy to 9.3 in army per I,OOO men. The
deaths from this cause are nearlv in the same ratio, between IO and II
per I,ooo, in both services, to the admissions " hurt" The inference
was, that slighter injur-ies are treated among seamen than amonlg
soldiers ; and that the increased ratio to meani strength or per I,OOO
force, 3 in the navy to I in the army, is made by the greater lnumber
of injuries and not by their greater severity; which is not borne out by
comparative lists of recorded injuries of a dlirectly fatal nature, wlhich
are strongly againist the navy. Reasons for this were assigned. The
excess of total mortality in the army per i,ooo, i6.6 against ii.6 in
navy, is made up by the deatlh-rates of diseases, -which stand as 15.3
army against 8.4 navy; showing the greater salubrity of ships tlla
that of barracks and camps. o fill the death-rate by accident of 3 in
the navy against I in the army per I,OOO men, there fell in battle i6, .

the average is for \V olverhamiipton, 6; 'Manchester, 8; Portsmoutlh, 12; 1.72 dliedl by drowning, and i. i6 by otlher accidents ; and, in the army,
London, 14; lIull, 20; andct Leicestel-, 47. The excess above the in battle .137, by drosvning .426, anid by otlher accidenits .435. After
aver-age at Leicester is thuls eight times as great as that of WVol- stating that miiedical hygiene had already affected very much in lower-
verhaimpton. In Scotland, town exceeds its average during the
no ing the dtetnih-o/ae by, (disense in both services, Dr. Smart descanlted on
hottest weeks of the year; but, on the contrary, the death-rate every- the possibility of siroilar results regarding the dath/i--ate by c(id7cents,
where is undler the averaae, and, in nmost cases, very conisiderably so. and suggested the good that might be anticipated if combatant officers
As rerards London, it lhas been shown by I)r. Arthur Mlitchell anld of both the public services were instructed in the laws of hygiene in
the aLtOlor (7w-onal of Sco//is/z Ale/eor-o/ogical Societ/, vol. iv, PlI, 229 their colleaes and schools.
andl 238), that if the cleatlhs of infants unnder one year of age be taken Ont t(e Anumei-ica/ na/tio of Disease in t//e A(dnlt .7thic Commnni/)y
from the total miiortality, the summer excess disappears from the curve (e(li(ceed fi-ome th/e Sinit/o)y Sta//istics of 11cr /A1k/es/l's Cnistonis, I oin'oon,
and, it is further slhowni that, if deaths from diarrlhema be deducted from fo;- (lie7years I857-74. B3y WVAILTER DICKSON, MI.D., R.N., Lon1don.
the wlhole mortality, the summer excess disappears equally as in the -The registrationi of disease is an acknowledged desideratum in public
former case. These results hold goodl for every one of the lar-ge towns medicilne. A more accurate and complete knowle(dge of the rate of
for 'which the require(l data. have been published. Lookinig, then, at sickness, and its inicidenice on various classes of the population, would
the large towns of England, Bristol lhas the least excess of infiant mor- throw' light oni some important social an-l economic questions, onie of
tality, the hiighest average of anly week being only at the rate of eiglht the most urgenit of whichl, at present, is the true position- of the niu-
calculatedl on ani annual mortality of I,ooo of the whole population. merous benefit societies established by the working( classes for mutual
In London, the rate rises to IO in the enid of Jtuly anid beginning of aidl in sickness, and comprisinig, accordine to hibh auithority, four
August; and in Liverpool it rises to i6, a rate which is also reache(d by miliolns of persons, and(l holding eleven millions sterling of property.
the deaths in Leeds, Hull, and Sheffield, and closely approached by a Very many of these institutions are knownvl to be in a most unsatisfac-
number of the otlher Eniglish tosvns. At l,eicester, however, it shoots tory filnancial conidition, in consequence of miscalculation as to the
lp to 22 all(n 24 in tlse seconid and third weeks of Augulst. The claims which they may be called on to meet. Miortality rates are ascer-
seasoni of miniimumii infaLnt mortality is everywvhere (lurin(g the spring tainied with mathematical precisionl ; but the ratio of indtustrial inlca-
moniths in the sixteen large towns of England. The smallest sprinig pacity, by reason of illniess, is as yet but imperfectly kiio^-vn in those
mortality occurs at P'or-tsmouth, the smallest summer mor-tality at classes of the coimmunity whom it most interests. The army, navy, police,
Bristol ; the largest summer mortality at Leicester, anid the laraest prisoil, anid Poor-law records do, or mi(ght, yield valuable inforination
mortality during the other nine montlhs of the year, at Liverpool. btut the bodies of men of whom they treat are too fluctuating, anid their
From the beginliing of November to the summiier solstice, the mor- circumstances too exceptional, to furnish reliable representative (lata
tality from diarrhcea is everywhere small, bein-g double, however, in for this purpose. In the sanitary statistics of the Customs' officers of
Liverpool and Manichlester as compared with Lonidon and Portsmouth. the P'ort of London will, it is believed, be founi(d a fairly correct esti-
hlie following is a list of all the large towrns of Great Britain arranged mate of the lhealth-conidition of the middle-class, middle-aged male
in the or-der of the greater or less prevalence of fatal cases of diar- population. They are, for the most part, resident in London, and oc-
rhcea (luring July, August, and September, the figures being the aver- cupied from eight to twelve hours in daily labour, attended, in most
age weekly cleath-rate for the thirteen weeks, calculated oni the ainnual inistances, with considerable fatigue and much exposure to the weather.
mortality per I,ooo of the population. En(g/o1nd` Leicester, 9.56; They form a permanent force, leaving it seldom except oni promotion,
Salford, 7.I5; Leeds, 7.02; MIanchester, 7.00; Liverpool, 6.28; Shef- death, or invalidin-; andl resemble in all essentials the majority of
field, 6.20; B3irmiiighalla, 5.78; lIull, 5.56; Nottinigham, 5.36; the well-doing industrious section of the community, who have to earn
 August 28, 1875.] THE BRITISH MEDICAL 70URNAL.
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 w,ill 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 niumerical ratios of 28 years
(which is equivaleit to that for one year of 32,000 men), are, mean daily
number incapacitated, 27 per I,OOO; admissions to sick-list in year,
700 per I,OOO; mean duration of each case, 15.5 days; time lost per
man annually, I I days, exclusive of Sundays, 9. 5 days ; mortality from
disease, 11.5 per i,o6o, anid from accident, I.3 per I,OO0 ; in all, the
deaths are 12. 8 per I, 000 ; superalnnuations or invalidings, 8 per i, ooo;
death and invaliding combiined, 21 per I,OOO; recoveries so as to re-
sume duty, 979 per I,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, II per cent. of deaths, and I8 per
cent. of the superannuations ; phthisis yields 1.4 per celnt. of cases,
8 per cent. of time lost, 31I per cent. of deaths, anid 9 per cenit. of stuper-
anniuation ; rheumatism andI gout show 14 per cent. of sickness, only
0.4 per cenit. of death, but 33 per cent. of superaninuation ; diseases of
the heart exhibit I lpe cent. of cases, 2 per celnt. of time lost, 13 per
cent. of the deaths, and I.5 per cent. of superannuations ; diseases of
the digestive organs give 17 per cent. of cases, 13 per cent. of tilmie
lost, 9 per celit. of deaths, and 7Y2 per cent. of superannuations ; dis-
eases of the nervous system amount to 7. 5 per cenit. of the cases, 9 per
cent. of time lost, 9 per cent. of deaths, and 20 per cent. of superannu-
ations, IO per cent. being for insanity ; skin and other surgical diseases
give I. 5 per cent. of cases, IO per cent. of time lost, but hardly any
dleaths or superannuations. Zymotic diseases occur in the small propor-
tioni of 6 per cent. of the whole amount of sickniess, and 7 per cent. of
the whole mortality ; and no instance has occurred in many years of
any officer having contracted suclh illness on board ship, a remarkable
proof of the extreme healthiness of the port of London in regard to
its vast foreign traffic, anid of the satisfactory healtlh of the Customs'
force. Phthisis andl heart-disease are the most fatal diseases, causing
one lhalf of the whole mortality. The former claims 4 per I,OOO men as
its annual victims, of the mean age of 4I years. Hea-t-disease destroys
I.5 per I,000, at the average rate of 48 years. Accidental injuries con-
stitute Io per cent. of the cases, I I per cent. of the time lost, and 9. 5
per cent. of the mortality. Drowning causes 4.7 per cent.; fractures,
etc., 3 lper cent.; andct suicide, I.8 per cent. of the whole number of
deaths. These deaths from violence amount in all to the rate of I per
1,OOO of the force.
Ont the A11o/0 ity of Adolescence. By JOHN BEDDOE, M.D., F. R.S.,
Clifton.-This paper w%as fotunided on a statistical basis, and clhiefly
on the figuies published by 'Mr. Charles Ansell, junior, of the Na-
tionial Life Assuranice Society. The author showed grounds for be-
lieving that puberty had an inifluence in inicreasing moitality, especially
amoilg young females of the upper class, the rates of girls of the lower
class and of boys of both classes being less affecte(; and he touched
briefly on- some questions of hygiene suggested by these facts.
77'w Cauiises of Iuivali(diin anoutz Convicts in /1ie Goves-umeuicjt P,-iso;is
of Eng-lan(d. By D. NIcoLSON, M.B., Portsmiiouth.
T o)bocceo, (1)( its LE fs on/ IL-alt/i of Ala/es. By CHARLES R
DRYSDAI.E, AM. D., London.- The author said that the result of a paper
by him read at Norwich had showni that, although very maniy, far too
miiainy he thought, eminenit plhysicians anid surgeons made use of tobacco,
yet none could be found bold enough to say that the practice of smoking,
chewving, or snuffinlg was consistent with health. The population of
the British isles used some foturteen millions sterling yearly in the pur-
chase of tobacco, pipes, etc. Nevertheless, there had always been
able medical objectors to the saiilte heiwre. The alkaloids contained
in tobacco, or in tobacco-smoke, were very poisonous ; and, when
smoke w,as taken inito the mouthl, a portion of such alkaloids dissolved
in the saliva, enitered the circulation readily enough. Smoke breathed
in small rooms, or railway carriages, also poisoned to a certain extent
all who inlhaled it, vhether smoking or not. The first cigar or p)ipe
showed the effects of acutie tobacco poisoning, producing niausea, vomlit-
ing, hiccough, dyspicca, prostration, coldness of the extremities, cold
sweats, and intermittent pulse. C/ir-onic poisoning by tobacco, the
ordinary disease seen in practice, was tested by Bilaton, who admi-
nistered two or three grains of tobacco daily to dogs with their food.
The animals lost appetite, had diarrhcea, swelled gums, loosen-ing of
teeth, irregular heart, paralysis of the hind legs, blind-
action of the
ness, and deafness. 131ack
teeth and spongy gums, with fcretor of
breath, were common in smokers. An affection of the tongue and
epithelioma of the lips was common enough in smokers. Tobacco
271
amaurosis was too wvell 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 camiie far too quickly
upon great smokers ; and Dr. Drysdale attributed, in some cases, the
occuLrrence of rickety children to the use of tobacco by the male parent.
B3rodie said of tobacco, that it tended to m-lake the race degenerate.
Sir William Jenner said smiioking tenided to produce palpitationl, prolapse
of the rectum, and impotenice. Mliller and Jolly alleged that chronic
tobacco-poisoninig caused palsy and insanity. Bertillon had shown that
smoking w-Tas most injurious to the funictions 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 pirefer good breath and clean teeth to
fcetor anti black stumps, andrdo not like to becomiie dreamy, nonchalant,
anid fractious, like the chroniic votaries of the pipe or cigar.
Ont the Evils 1f ilLedica7l l/en aitnde-takniig t/1e Dutties (if AVzlses. By
A. FREER, MI. C. S. Eng., Stourbridge.-The growing disposition of
the richer classes to lhave their medical attenidants to niurse tllem
duiing actite but ordinary illnesses, should be wvatclied witlh regard to
the initerests of both doctor and patient. Why in such illnesses should
the medical man assumiie the duties of a niurse ? If the attendance of
a imiedical man be demainded during several nights, this should be given,
not by hiIm in charge, but by some one free from the anxieties of
genieral 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 ; aiild the first look at the invalid after a night's
absence must not be lightly foregone. If the miiedical man stay in the
house of the invalid all the time, the frienids are tenipted to put undue
pressure upoIn him to prescribe some fresh remedy at every change for
the worse. Perlhaps, in the niglht, the patient is stirred up anew to receive
a freslh attentioin. If the medical man suggest niothing more, disap-
pointment is felt by the friends. They do lnot understand, as he does,
that time itself is a remedy witbout wlich 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 becomiing more impatient
of the restraints of illness, and expect mna-e from miiedical men than
they used to do. But these must not be willing at every call to come
down from the hill of observation iiito the battlefield to do the work of
subalterns ; but if this be forced upon them to a greater extent in the
future, it is to be hoped that the notions of the public as to remunera-
tioii for unnecessary detention keep pace with such serious claims.
The Training,- of Aurises in Pi-ovinzcial Iospitals. By EDwARD
WATERS, AM. D.
friday, August 6th.
The Section met in the Chemistry Class-room; Dr. LYON PLAY-
FAIR, M.P., in the Chair.
GRoup C.-GENERAI SANITARY ARRANGENIENTS: DRAINAGE:
WA'ATER-SUPPLY: VENTILATION.
T/ie Sauitaiy State of Rome.By LAUCHLAN AITKEN, M. D., Romne.-
It was, he said, useless to cleniy that the sanitary reputation of Rome was
of the worst possible character ; anid it hacd been, and -as, so much the
custonsi to write antd speak of its unhealthy state, that they need feel no
surprise if many still associated the name with ideas of danger or dis-
ease. M\Iany visitors came under the influence of that feeling; he
might lhave said nearly all, except perhaps a few sentimental young
ladies, who founid 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 wvhich 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. I per ioo1, due
to an epidemic of small-pox which had spread over Europe fronm the
war-strickeni provinces of Fralnce ; a great increase in the deaths from
diphtheria and croup, the effects of the inundation of the Tiber at the
end of I870, when two-thirds of the hotuses 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 anid steady employment. But, since I872, there
hadl been a gradual improvement. The effects of the flood had ceased
to tell on the (leatlh-rate; better accommodation had by degrees been
provided for the new-comers. \Work had been easily got by all steady
men, wages had beeni Iiigh, 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
borrow,ed largely, and spent money to im;prove its sanitary state.
 272 THE BRITISH MEDICAL
Amoing other things, the dlainis in the so-called English ouarter had
been thorooughly repair-ed or entirely rebuilt. The cleansing ork was
better performed, andl, if the scavenger-s still seemed to take things
rather easily, yet every onie w%vho knew Rome only a few years ago now
readily admitted how itclich pleasanter to the eye and nose it hiad be-
come. Ouitside the city walls, too, tlherc hald heen progress, tlhough
not to a corresponding exteint. Garlialdi's plans w-ere nlot imprac-
ticable, aid(l would pruobably lhave the de-ired effect. 'Meantime, miianly
of the proprietors were engaged in planting the Campagna with fast
growing young trees. Fiom the reports issued by the Statistical Office
at the Capitol, it appeared that, in 1872, the proportion of deatlhs to
the population was 40.5 )er IOOO ; in 1873, 344.1 ; inl 1874, 33.9 ;
aindI foi- the first five monitlhs of this year, 35.1 . Those fiatgmes, how-
ever, presented a fictitiotis mortality, a-s they inlc(led in thle returns
fromii the hospitals an(I city the cleatlis of inuany plrsonsm not belonging to
the community of Romie. After -aling the due (ledluctioni, thle mllor-
n reason
tality a.sstum-e(d very (tieiit pio ltorions, being, in I872, 37.1 per IOOO
ill I187, 29.1; ill IS74, 26.2; a-nd in tlhe first five montlhs of I875,
29.1. rglnt of tc dets amo i-ghose xivho hlad n-io fixed resi-
deuice in Rome occiir d- in the hospitals; and, indeed, the admissions
of immiiiaigi-ants fi-om otlher prosinces of Italy inlto those instittutiorns
greatly exceeded those of the poorer classes of Romne. The patients
in the hospitals belonged mainly to the cenitral and( soutlherni provinces
of Italy, the miajoiity )ei!ngr peas.ants, who arrived at fixed seasons to
till tlle Campagna or to reap) the harvest, while others were miasonis or
bricklaycrs, %0ho ecstabli hahd tlteinseives- in Romie xvhen xvork was
plentiftul, but who 1ad nlot vet beeni incltudedI in the population. The
fluctu-atinig population xvas almost entirely male, and, as the occupations
of the peasants exposcl thelm- to the m-ular ia duliiiig the wvorst season,
the deatlhs were enormous. They were said to be 6 per cent. annutally;
but that wvas probaldy unider the tr-oth. No doubt also the unihealthy
state of the hospitals hiad mluilchi to do with the excessiv-e mortality ; the
deaths in the hospital.,d inideedl, amounited to nearly half the mortality.
Although the dleathi-rate in the lhospitals of those not beloningfr to the
commtuniity was high, it did not seem to be so among other strangers
in the city. Referiing to Romani fever, he remarked that a great many
cleaths were registered fromii this cause which wsere really not caused by
it. Ile lhad niever seeni aniy case amoing visitors to Rome (luiiing the
xvinter monitlhs -which could be so described. In conclusion, lhe said
that a modler-ni Romani hadl inearly as goo(d a chance of life, and w-as no
moi-e likely to die fiom a preventable (lisease than the citizens of Edin-
burghl; and it was possible that, by the statement he had made, part at
least of the fear of a visit to the Eternial City nmight be dispelled.-
The PRE-SIENTr said that personally he had not a very good wvord to
say for Roine. He xvent there, and oni the third day took that fever.
Durin, his convalescence, lie thoug,ht a good deal as to -what Nvas the
cause of the fever. Ile di(I niot know' that he came to a better con-
clusion thani anyone else. 13ut one thing struck him. In ancient cities,
sIIch as Rome and Jerusalem, the 0'l)ois of many thousand years, which
lhad accumiilatecl and raise(I the level of the surface, conitained a large
quantity of oi-ganic remains, wvhich lay clormant until excavations w%vere
made, wlheni the oxygen of the air commenced an incipient ptitrefac-
tion, and produced malaria. At all events, lhe kn11exv exactly the timiie
wvhen he wvas stiuck. It was while lookinig at some nexv excavations
vhich were being made in the Palace of the Csaars. Ile thouglht it
would be very initeresting if 1)r. Aitken -%vere to obtain an instr-ument
for ascertainiiig the exact amount of organic matter in the air by
means of permaingalnatc of potasl , and examine the air before an exca-
vation had commencedl, and after it was in progress. Some initerest-
ing conclusionis couldI be obtained in that vay. The enormous mor-
tality among w%orkmen in the hospital had been miientiolned, anid it xvas
qcuite possilble that tlhe xx-orkmen xere stricken clowvn xhile excavating
ruins, makincg nex sexers, or taking out the founndations of nexv houses.
-MIr. W. J. COOPIsIR (Richmonid) pointed otut that great mortality also
occurred in Jerusalem among, the jexxs. The sexvage of cenituries had
sunk into the dbi-is, and(l, xhen it xvas dlisturbed, malaria set in, ancl
the mortality xx-as very great in consequence. In I854, an old clay
pit xvas openied ill BIroacl Street, London, xvhich emitted a very foul
smell. Cholera camiie shortly afterxards, and Goldeni Square, a(djoin-
ing, was almost depopulated.-Dr. GRIGOR (Rome) thouglt the uin-
healthine-s of Rome as a xvinter re-idence xvas very much magniified.
The commniunity xvas slmiall, and aniy fatal case made a great noise. He
xvas satisficcl that Romiie had as little tvphoid fexer as Edinburgh, or
any tox1n lie knexv, in proportion to the population. He did not
think a great deal of typhoid xvas genierated in Rome ; xhat they had
xvas an agiie or malariouis fever. Typhloi(d vas imported fiom other
cities. He beliexed that the malaria among the xvorkmen xas due,
not so much to excavations as to the poor constitutions of the men,
cauised by their poor livinlg and wretchecl lodgings.
YOURAAL. [August 28, I875.
Ont the Sanitationz of Iou.ses, e.Vecially wzi/li reference to Drainage.
By WV. EASSIE, Esq., C.E., London.-The evils of improper drain-
age i-ere best obserx-ed in houses that had been from time to time addecl
to. Onie wxas then able to trace the first awakening up of the inmates,
xvhen the patrimonial cesspool had filled up and choked the drains.
When tlis happened in villages, all that wvas done xvas merely to par-
tially emipty the receptacles and clean otit the drains. And wzhen this
lhadl occuLrred several times, a nexv dumb-well vas sunk and the drainis
led inlto it, the old pit being covered up with a stone. It wvas cheaper
to do this than to fill it up ; and, besides, this procedure did niot neces-
sitate the absence of the family. It xvas the same in toWxls, and lately
Mlr. Eassie laid bare in a West End London house thlree cesspools
wvhich bach been dug in proximity, and abandoned in rotation as they
filled tip ixith orldure and filtlh. Fouir cart-loads of night-soil xvere re-
mox-ed, xhich couldl not have seen daylight for half a century. The
by these anicient nuisances xvere fotlnd in-side houses in toxvns
and ciLies was niot because they could not be accommodated outside the
houise, but because the slops from the kitchen and batlh and laundry
xvastes v-ere insufficienit to flulsh the more solid xastes outside the xx-alls.
In neaily every case, too-, the drains xvere of brick, laid xvith uneven
bed, and through the joints of which the fluids percolated. For in-
stanice, a cottage xvas dr-ained iilto a cesspool in the kitclheni, and, when
that xas full, anotlher xas dug, until tile place xas honeycombed xx'ith
them, the subsoil saturated, anid the xxell poisoned. A comlimoni privy
xvas used in the yard, anid this performed the same evil functions.
By-and-hiye xvater-closets xvere introduced, and earthen pipes, and the
cesspool for these wvas dug in the gardeni, xvith a lower onie for an overflow,
an(d botli cemented dox1n air-tight fashion. There wvas no ventilation,
except tlirough the trapping-vater of the syphons. Drainage into a
cesspool was niot necessarily dangerous, provided only that tile vaste-
pipes of the sinks delivered outside over a trap ; provided, too, that the
soil-pipes xvere carried roof high, and a foul-air xithdraxving-cowvl fixed
uplOll tilill, all xi-ould be xvell. It might, in some cases, be absolutely
necessary also to ventilate the cesspool by an upright shaft, or a veenti-
latincg charcoal trap in the stone cover ; and it might evenlbe wise oc-
casionally to ventilate the march of the drain. Where a common privy
xxas used, an eartlh or aslh-closet ought to replace it. Wlhere a parishl
seiver xvas put in the main road, and the value of the land enhanced so
mulch as to make it xvorth while to enlarge a building, sometimes half
of the honise xvas drained into the sexver and the other half into the oldI
cesspools. The old cesspools bach not, hoxvever, been dug uip in the
basement of the houise nor the urine catch-pit in the stables. It lvas
very easy to so arrange the plan of a house that the whole of the ivastes
might deliver immedliately outside the house, and to have nothing but
the outside xx-all betxveen the ivater-closets, lavatories, anid sinks. When
it Avas advisable to dr-ain the basement, it could be disconnected from
the main road by illterposing over the junction a ventilating shaft. The
sinlks and lavatories should all deliver over an open chamber. Tiie
xx-alls of a house sloulcd be built hollowv, and protected from rising damp
also by a pioper damiip-proof course.-Dr. CARPENTER (Croydon) said
there xvere three canon laws that ought to be observed with reference
to the disposal of sewvage-(I.) That ill sex-ers in connection Avith
houses, stagnationi should not be allowed ; (2.) that there should be
free ventilation, the air, however, not being allowed to pass inside the
dxvelling-house ; anld (3.) that there shouldt be no communication be-
twveen the sewage and the water-supply.
Onz AMor-tality in relation to Dwellings. By GEORGE Ross, M.D.,
London.-Dr. Ross commenced his paper ith questioning the correct-
ness of the ordinary statement that " the mortality of a population is
in a ratio to its density", and affirmed that " Iiigll 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 wxould use the resources at their command. There need lie
no stagnaant wvater, nor festering heaps of dirt, no decaying vegetation,
iior otlher nluisance in cities, if proper cleansing were systemiiatically re-
ted to ; ailcl houses might be built, even for the humblest, upon
plans that xvould secure amlple ventilation, and promote the health of
the occupiers. He then described the condition of houses in towns as
they iloxx exist, and pointed out their characteristic evils ; affirming bis
belief that the chief catise of the high mortality of an urban population
is tile bad construction and squalor of thleir liomes. The new Act for
tile improvement of the dvellings of the working classes xould, it was
hloped, remove the w'orst of these evils. Dr. Ross then explained a
series of tables to show the direct influence of unwholesome houses in
producing disease and premature death. lie gave a list of thirty-two
streets in St. Giles's district ; and showved 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
there was a gradual declension until, in a square at the bottom of
the list, there was only death in 4I houses from the same diseases.
i cretal matter should be allowed to pass into the drains at all; it should
Again, as regards population, Dr. Ross showed that the mortality
from the same diseases was more thaan thirteen times greater in the
street than in the square. In Chapel Place, a court of small cot-
tages, the death-rate in 1870 w-as 69.7 per I,000, and all the deaths
were caused by the (liseases named. In Queen- Street, the deatlh-
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 accounit for the difference of mortality. The mortality in Chapel
Place from zymotic diseases was I6.4; in Queen Street, 9. 7; in Chlurch
Lane, 8.4; in Dudley Street, 6.2; and in Wild Court, 5.6 per i000
living. Dr. Ross then compared the deatlh-rate in three blocks of
buildings, under the management of the Society pi esided over by Lord
Shaftesbury. These blocks were similar in size, had the same careful
attention, anid were occupied by a similar class of people, and
fered materially as regards their structure anid surrouni(dings ; alnd he
showed that, in one year, the tleath-rate was, in one block of the model
houses, 4.6 per j,ooo; in another block of adlapted houses, I8.2 ; and
in the third-a very bad old block, but adaptecl according to the pre-
valent notions for promoting health-36.5 per 1,ooo. The sanitary
condition and mortality of portionis of the Whiteclhapel District ere
then detailed, the facts being collected from MIr. Liddle's Reports.
The results wvere similar to those in St. Giles's district. The -wretched
habitations in Farthing- Alley and Rose Court were described-houses
consisting- of two and three rooms in narrowv courts, without proper
sainitary consveniences, and vithout the possibility of venitilation. Dr.
Ross statecd that there were many acres of this kind of property in
Whitechapel. Dr. Ross then reverted to his origilnal proposition that
mere density was not necessarily a cause of disease, and illustrated his
argunment by a reference to the high density of population in model
dwellings, and the associated low death-rate. He also stated that
already in some parts of the metropolis the density ranged from 6oo
to 2000 persons to the acre. The difference in the mortality was caused
chiefly by the difference ini the constructioni of the lhouses alnd sanitary
arranigemenits. It w-as not density, but dirt, that had to be guarded
against. The defects of site, construction, and arrangemenlt, that make
houses unhealthy, were then briefly stated, strong emphasis being placed
upon the evils arising from the bad foundations of houses. Dr. Ross
inlsisted that all dwelling houses should be btiilt on concrete or other
impernieable material ; as all porous soils, including gravel, let in the
water, and made houses unwholesome. Brick houses, after a certain
periodl, became unfit for habitation on account of the absorbing pow-er
of the brick, wliich retained miasmatic poisons, and kept uO) a succession
of attaclks of zymotic diseases. Many of the remarks iii this part of
the isaper were evidently made in allusion to the powers for condemna-
tion given to medical officers of health in the nesv Act of Parliament.
Dr. Ross concluded his paper with a list of suggestions in respect of the
sanitaiy requirements to be observed in the erection of nesv dwellings
for the wvor king classes.
Santitary Z/enia-ks to Ti-ap andt S&il-Pi es. By A. FLEIGUS, MI.D.,
Glasgowv.-Dr. Fergus said he had for some years been ilsvestigating
diseases connected withl excremental pollutions ; and, at the Birming-
ham meetinig of the iAssociation, lie had draw-n attentioii to the danger
arisinig from decayed soil-pipes. Findinig that the perforations wvere
always in (fry portions of t'le pipes, anid made froims the inside, hie con-
clutded they were causedl by sewver-gas-aii inference sustained by clie
mical analys is of the pow,vdery corroded matter, and by the fact that
N-entilated l)ipes lasted longer than close ones. Tlse specinclls he ex-
hibited lhad all been wcll trapped ; and as tension sufficient to force gas
through tlse trap 'was too rare to account for such an action, he wvas
forced to the conclusion that the gas as eitlser generated in the trap
w and then the o-erflow wv.,s simply dealt with oni the above system.
itself, or was absorbe(l by mlIescvater at the outer endl, and giN-en off at
the inner end, or that both of t1fese thinsgs tookl place. That diffusion
by the latter means wvas likely-indeed, inevitable-he had proved by
fiequiently repeated experinments with model traps, whleli a little gas
(w ithout pressure) on one si(le, was always found to diffuse itself through
the water, and, in a vely short time, to ilidlicate its preseiice bsy chemical
tests ol the other side. This happened whether the gas was light or heavy,
and tlse most thorough ventilation only made its passage a little slow-er.
IIe la(l recently been giving iiicreased attention to the otlher source of
gas-viz., generation in the tral) itself. lIe invariably foundl that part
of the freces floated on the surface of the water on the liouse side of a
trap or cesspool. Flhilsling only agitatedi witlhout removing them, and
thien they dlecoimposed until dissolved. The gas so generated must
either pass tip the main-pipe (if connected) or into the house ; and was
more likely to do the latter, on account of the higlher temperature. He
gave minute particulars of a representative case in a good locality in
the \Vest End of Glasgow, wlsere typhoid fever, casually introduced,
_OURAVAL. 273
was spread in this manner. The true sanitary remedy vas that no ex-
be dealt with separately, and, within twenty-four hours of being voided,
should either be returned to the eartth or subjected to chemical or other
action, rendering decomposition impossible.
Ont 1/ie S&anitoay ZnJ;ozvwzeuzts of Counzlit VdloA'es. By G. WIL-
SON, M.D., Leamingtoni.
On thec Conzpa;-atizve A1-eri/s ofl' l,e l Cori-ii&e a,ss D ;y 5's/usens of
Scwo7,ee flromtJ a &Sni/alz;), and JEco,ozomiical Point of Vitrc'. By G. A.
KENYON, M. B., Clhester. -This paper set forth the conclusioins
arrived at by an imipartial inquiry ilnto the respective advantages alnd
disadvantages of water-closets, versus dry methods of removal of ex-
crement for urban commtunities. These conclusions w\erc, in slhort, to
the effect, that if r-emooval at intervals of olne wveek or less is to be
inlsisteel on, then the only advantages that can be pleaded in favour
only dif- of (Iry systemiis is, the saving of the wvater that 'would otlherw-ise bc
requirecl to fllsh the closets ; anid that the qjuanitity of -water tlhus
saved miiay be taken to be equal to one-sevelutlh or one-sixth of the
smiiallest amount nieedfuil for the convenient satisfaction of the other
requirements of the communiity ; an amiiount that wvould seldom be of
serious impor-tanice. The experience of too (Cov entry, W' rarwick,
us
w Bristol) in. which the use of w%ater-closets is universal, was qlloted to
show that no serious difficulty is encountered fi-ommiiisuse by thel poorCr
inlhabitants. The danger of introdtucing sewver-gases inlto houses m11ay
be enitirely avoidedl 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 wvith in disposinig of the conitents of the
pails in one laige town, yet the -orkinig expenses are so great as to
excltide tlle idea thiat, on this account, the l)ail systemii lhas any advan-
tage over water-closets ; 'whilst thlere is, as a imatter of fact, a good
deal of niuisance conniiected with their use, anid nlot the same security
from the risk attendinig the dleposit of infectious evacuations or dis-
clharges whicli is afforded by the water-closet. If removal once in tlhrec
monitlhs wvere sufficienit, thtere Nwould be attainable, at a smnaller
expenise, a g-icat impiroement in. the old state of thilnes in a town
by filling up all uindcerground midclens or cesspools, excludilln rain,
distributing ashcs, andl so arranging, that any excess of mlioisture, suzh
as w-ould be occasionied by iniadvertently emptying slops tllerein, should
escape alonig a surface channel to the yard-gtully. Thus, there nleed be
no drain iniside, anid nio ashcs coutldi get into the sewvers; nior wi-ould the
initerior remain wet; and tlherc would be a aining, afforded which
w
would tend to prevent a repetition of misuse.
T'ie Dainagzqte and otheir Sanilari' Colicti'ons of Rnr'al Dish-ic/s. By
J. A. DAVEN PORr, Esq., Nantwvich. -In the course of a paper, in xvhliclh
the questioni of rural drainage was dealt w!ith, 1Ir. Davxeiport said
that, of the systems of dealing with lhouise-slops and liquid refuse, one
wvhiclh seem-led to answer in. the district with which lhe wvas conniiected,
was that of subirrigation carr-ied out either in the gardens or fields ad-
jacent to the dwelling,s, sometimes in. colnnection witlh a little tank, anld
sometimes without ; where there was no tank, the slops wvere tlhrowni
to a trappedl grid, below which there wvas a strainer to prevent aniy
matter from passing, likely to choke the drain ; where it wvas necessary
to prev'ent pollution of the soil, larger sanitaly pipes shoulrl be used
but, wlher-e the liquid was dealt with, common pipes ere used (some-
times wvith sockets), and at every tw-o or tlhree feet, spur pipes branched
out for three or four pipes' iength ; these drains -were placed ten
or twelve iniches below the surface, and the liquid soaked from themn
into the soil. It was necessary, howvever, 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 xxas prefeired to allow the wvater to drain
into a little tan-k first, properly placecl, to be kept for garden purposes
Sometimes he had utilised a dceep (litch, runniing the overflow irrigating
drain parallel to it, and allowing the liquid to filter throughi the initer-
vening soil. If the upper drains shoutl become choked, it wvould be
but a small matter to take themii up anid relay them ; but he had in his
district a block of eigiht or teni houses that lhad been dlrainied oni this
systemii for two years past, anid all wav;ns working well up to the present
witlh no signs of chloking. AMost of the %vork was rotughly donie, and
under conditions renderiig a good result a matter of doubt. Still,
some
so far, it was as satisfactory as miglht be expected. The difficulties in
persuading and arrang-ing as to this particular system hadl been great
for ordinary people (lid niot quite comprelhend it. The only principle
that lhe lhad considered it safe to act upon, was to deal wvith all foul
liquids by the soil ; get themi properly on to it or through it by somiie
means as quickly as possible; and, in suggesting any rural drainage,
he always kept this end in view; and the systemii 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
 *274 THE BRITISH MEDICAL
generally be found to furnissh 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 subirrigation.
Greater difficulties witlh these subirrigating systems might be experi-
enced where the soil w-as excessively stiff, but the ashes from the house
and the refuse from the gardlen burnt, together with other substances
tending to lighten it being mixed tlherewith, would in some degree
tend to remove the difficulty. Probably for villages, etc., no better
method of dlealing writh their sewage couild be adopted than that pro-
vided by the automatic sewage meter-tank.
Drinkink and Table 1(Voteis. By C. H. BARrLETI, Ph.D., F.C. S.,
London.-The paper commenced with remarks on the necessity of a suf-
ficient supply of aqueous fluiid for the due performance of the functions of
animal life, and the funidamenital part wtrater performs in the transforma-
tion of foo(d into the animal tissues and in the elimination of the wi-aste
products of the system. The agency of wvater 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 neNv method of pursuing mc(lico-chemical
investigations w,hich mialgt pave the way to the identification of the
specific poisons of inifectioni. He then noticed the precautionls required
to prevent driniking w,ater from disseminating disease. Chemically pure
water wvas unattainable anid unniecessary. The geological sources of
water-supply, as affectinig its wholesomeness, were considere(d ; and the
reason was given wbhy the wvater from surface-wells and alluvial soil is
generally unifit for di inking. The niature of dlifferent organic impurities
in water was described ; and the means of discriminating those which
were dangerous from others less objectionable vere mentioned. Re-
marks were made oni metallic poisons in solution, and on the fallacy of
the usual standard of estimation. Autumn was the period wNhen well-
water was most liable to dangerous impurities. The aulthor described
the means of prevention of lead-poisoning, by the use of tin pil)ing and
a newv filtering mediuim wlhich removred both lead and organic matter.
The dangers of common a&rated waters made with impure chemicals,
and the necessity for a great alteration in the ordinary apparatus for
their manufacture, -were pointed out.
On Ventilationt, with M31odel of Ap/5oratus. By G. GOLDIE,
L.R.C.P.Ed., Leeds.
Thze Ex/jense ef Ventilation and TVo;minZg as Sanitary Isefuiu-enments.
By JAMES A. RUSSELL, M1.B.
On the Mlineral Cotustitttentts of Drinkinlg- Vale;-. By J. A. W""ANK-
LYN, Esq., London.-Mr. Wanklyn said that ithin the last ten years
the pi-oblem presented by the organic matters in water had been
solved. Chemists would do well to return to the inorganic materials
in driniking-water. It was a well established fact that, by filtration on
the large scale, the organic matter in drinking-wvatcr might be so far
removed that the water might be made to reach the standar(d of purity
attaineed by good drinking-water ; but, if there were objectionable
mineral mliatter in the water, there wNas 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 wvas 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 individcual 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 phosphate of magnesia, a little phosplhate 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 dlay 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 IO grains of
mineral matter derived from the drinking- water. Putting on one side
the common salt, which w%as artificially added, the mineral matter of
the foodcl did not by any means overwhelm the mineral matter in the
drinking-water. he question had often been asked, -whether the car-
boniate of lime present in many hard aters might not be needed by
w writers were specially noticed. Cases of one-sided hallucinations of
the animal economy. If the only other source of lime were the flour
consumed as bread, there miglht, ilndeed, be need for the lime in tIme
drinking-w-ater. According to the recent analysis made in Mr. Wank-
1 yn's laboratory, there is very little lime in flour, one pound of w,hich
contains onily iS2 grain of lime. Hle believed that a comparison of the
mnineral contents of the ordinary dietary of a population writh 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 150 grains of which were required daily by a
70URNAL. [August 28,1I875.
=
man. He believed that salt-famines must occur, and that whole popu-
lations must occasionally suffer from deficiency of that material; anld he
once recommended a water-supply with 8o grains of salt to the gallon,
in a case wlhere 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, whiclh is notoriously charged with a considerable amount of salt,
7as 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 foulnd to contain a large proportion of salt. Apollinaris wvater 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 anotlher illustration. Bearing these facts in mind, the
conclusion was, that wvater-drinkers should add a little salt to the wvater
-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-w%ater other matters, some of which were not
nutritious, being to a certain degree poisonous, or being me(licinal. 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 shlould be set at not much over I.O grain
(carbonate of magnesia) per gallon of water. In Thames water, he
founid o. 7 grain of carbonate of magnesia per gallon; in the Kent Com-
pany's water, 1.3 grain. A curious example of a magnesian *water was
afforded by the St. Ann's Well of Buxton, the water of wAhich, accord-
ing to the very careful analysis of Playfair, contained 4.7 grains of car-
bonate of magnesia per gallon.
Vote of Thzanzks to th1 Presidet.-Dr. A. P. STEWVART (London)
moved a vote of thanks to the President, Dr. Lyon Playfair, whose
presenice had done honour to the Section. [Loutd aoflaouse.] One of
the few real statesmeni, 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, wvould be strengthelned in the
future. Dr. Playfair lhad 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. [A/plouse.]
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., Sonitas sanitatunm, o;nnia sa/itas; and
Saolts p0/htli su/rtemnaest lex [app/luse] for hitherto what had been
introduced had been defective to a considerable extent. [flea;-, heol-.]
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 fIealth from different parts of the kingdom; because, although
they had corresponded and co-operated together, still the presence of
so many aentlemen interest2d in this great subject-which the leader of
the present government had justly said was the great cubject of the
future-encoturaged 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. [A/pplouse.]
SECTION E.-PSYCIHOLOGY.
WVednzesdoy, Augutst 4th.
THE H. LOwVE, delivered an address, which was
President, Dr.I IV.of the
published at page 76 JOURNAL for August 7th.
Thze Disoriders oJ S/eec/i in Insonity,. By T. S. CLOUSTON, M.D.,
Edinburgh.-A discussion ensued, in which Dr. White (Aberdeen)
and Dr. A. Robertson (Glasgowi) took.part.
Obserivationts ont the Unilatera'l fhenomenza of Menztal and A-rv'ous
Disorder-s. 13y ALEXANDER ROBERTSON, M.D., Glasgow.-After
some preliminary observations, unilateral mental phenomena were first
considered. These consisted of illusions and hallucinations, and pos-
the peculiarities stupposed to be due to the separate anld
sibly also of action
independent of the hemisplheres. The observations of French
hearing werethese quoted from Gall, toGriesinger, and Schrbdcr van der
Kolk. Btut cases appeared 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 BRITISH MEDICAL 7OURNAL. 275
to be more distinct in that car than the other one. The became contracted and distorted also, but came rigbt in a few days.
the other senlses wrere then referred to, and afterwards The treatment consisted of stimtliating injections, bromide of potassium,
anid blistersto the nape of the neck. The most interesting point, perhaps,
details

cases of unilateral auiditory hallucinations were given. phenonmena

in the case, -was tlbat, under chlorofoim, the contraction of the right foot
The

were most apt to occur in the m-lilder and more ephemeral forms

insainity, anid particularly when it had beeln caused by was reduced. A splint was subsequently applied for a week, and now
liquors. lhe frequency wvith which the hallucinations were associated the limb was as well as ever. The left foot had since been treated in the
with the left ear w,as very striking, and it was pointed same way. It was already much improved, but, from the longer con-
cases quoted from the above named authors were also on side. tinuance of the contraction, the result iil this case must be more doubt-
The pathology of the phenomena wvas then considered at length,
ful. The questions arose, Was this a case of true epilepsy? Could
and also the indications derived from moldern research anatomy,
it be a form of bysteria ? or bad the " aggravated hysteria", from
physiology, and pathology of the nervous system as to their ana-
w%hich she had suffered, gradually developed into epilepsy? or was it
tomical seat. The seeming- dual action of the hemispheres w-as probable that there was organic disease ? Dr. Deas was led to tbink
illustrated. Thereafter, unilateral motor phenomena discussed, that the case must be classed as one of epilepsy, from the following
the observations being restricted to the convulsive class; anid number considerations. There was an undoubted " discharge" during the
i.

of conclusions wNere stated, some of which ere published fits. 2. The patient had a sensation or "aura". 3. There was com-
in I869. First, convuolsive movements may different begin in plete unconsciousness during the fits. 4. There were closure of the
the body in the same case, evemn though there nio is reason think glottis, venous congestioni, frothing at the mouth, and stertorous breathing.
there is aniy appreciable change in the cerebral lesion. 5. There were none of the ordinary signs of hysteria. The patient
unilateral convulsions, the so-called bilateral muscles complained much of pain in the head, especially in the intervals of a
cated, but the twin muscles of the otlherw ise sound in series of fits; she-sometimes asked to have it cut open, or that she might
do not contract so firmly
as those on the sidle first convulsed. The be killed. Dr. Deas thought it possible that there was a soturce of irrita-
physician- may, therefoie, often ascertain for himself tion in the brain of an organic nature, but whether of the nature of
consvulsions the sidle oni which the convulsi-;e movements deposit, tumour, or other change, it was impossible to say. This view
(and, consequently, the hemisphere affected), by simply grasping was consistent with the marked predominance of tonic spasm, and the
limiibs of the two sides, and comparinig the dlegree prolonged contraction of groups of muscles.
respectiv-e muscles. Thirdlly, there may he(il/e/-note
of the eyesdutring the same convulsive seizure.
of

conjuaate Emiotionzal Aphasika.

By D. DE BERDT HOELL,F.R. C. S. E., Clap-
ton.-This affection, wlhich mighlt be distinugished from that more fre-
Fourthly, general

rule, thehigher up the lesion is situated the more quently bearing the name, by being usually of temporary duration and not
aie to become bilateral. Fifthly, when convulsions side, begin the result of organic disease, was illustrated by the case of a lad, sixteen
there is frequently adistinct anid sometimes prolonged a interval years of age, who, with an interval first of six, and next of eight weeks,
consciousness is involved; and it is occasionally retained
lost the power of speaking, but not of thinking or writing ; on the first
the whole seizure. Sixthly, there is a decided increase occasion for twenty-fourhours, on the next for forty-eight, and the third
in the consulsed members. All these conclusions illtistratecl were for one hundred and twenty hqurs. He recovered perfectly each time.
cases. With respect to unilateral senisory phenomena, was The attack was brought on, in the first instance, by fatigue of speech from
mitted that there seems less dispositioni for the irradiation prolonged effort of talking, combined with excitement and anxiety. It
tions" fiomii onie to both sides, than for the extension was conitended that this wvas an instance of aphasia proper, i. e., accord-
gcneral consvulsions. The greater regularity of the
ing to the Lexicon, of speechlessness, from fright or emotion, and that the
senisory symptoms was also dwvelt on and illustrated. surveying- disease towvhich the name is usually appliedw-ould be more properly
different classes together-, it was observed that one-sided (lisorders described by aphemia, if that were a classical wvord, but, that not being
motion and sensation had their analogues in unilateralhalluciriations, so, by the aphasia atactica of Dr. Ogle. In explaniation of the symp-
aind just as the partial might become general in might the one case,
toms, it was asstumedl that the vaso-motor nerves were the seat of the
alsoclo so in the other. Astriking illuistration of gradual disorder.-A shortdebate followed, in w,vhich Mr. Lennox Brow-ne,
of illusions of vision into insanity wvas submittedl. Lastly, Drs. Down, Gairdner, anid Cloustoni, took part.
servations ercmladic oni the irregularity in the ordier
Th111-sdea, Au1gu9st5t/k.
of

thesephenomenia as coml)ared ith noi-mal

MI. Dupuv(P'aris) refeiredi tohis own
physiological

experiments on
YStltistics of Lunacy7
in 7ownt aznzd Count;'y.
BI y JOHN SIBBALD,
cauterising one cerebral hemiisphere, in which he ha(l M.D., Edinburgh.-Dr. Sibbald exhibited several tabular statements
of the same side of the body as a result; while a subsequent cauterisation illustrating the statistics of lunacy. He pointed out that the problems
of the oppositehemisphere appeared tohave a counteracting effect, to be solv ed before these could be properly understood were of
paralysis then disappearing.- Dr. Clotuston, Dr. Yellowlees, Dr. Deas,
great complexity. The figures wvhich he had collected in the tables
and Dr. Bramwell, conitinued the discussion. shown were intended to illustrate one branch of the subject. They
A7/es of Unusual Casc, of
an Ep;hj// BB sj'. y P. MAURY M.B., showed, among other things, that the niumber of pauperlIuiiatics in
MIacclesfield.-Thisw-as a case of epilepsy, complicated mania, bult
Scotland persistently chargeable to country parishes is larger than the
number chargeable to towns, being 206 perioorooo for the country,
also presentinig some unusual and anomalous symptoms,
str-ong-ad apparentlyhealthyyoungy-oman. The epilepsy and I77 per ioo,ooo for the towns. On the other hand, the number
ycars. Before that, shewsas subject to "aggravated hystei.ia". Maniacal annually added to the roll of pauper luniatics from among the residents
synmptomns first
in
showed themselves eight months ago. was
of country parishes is smaller than the number occurrinig among the re-
sidents of towns, beinlg 35 per IOO,,OO
in the one case, andI 56 in the
treatment the Northlampton Asylum for mlionths,
four

Clhesire Countity Asylbm for the last six weeks. Oni adlmission, other. He showed that this is probably accounted for by a large
left foot wvas founid to be conitracted andl distorted, exactly
number of patients requiring only temporary treatmenit being sent to
ease of talipes vartis. The patient, who wvas veiny rational
asylums in tow ns, who wvould be allowed to remain at home in the
she had a bad attack of fits last Chmistmas, whvile in service, wben country. He adduced arguments anid figures to show that the appa-
she came to hierself she
in the uinionI and her
was diistoi, as was foot renitly enormous increase of lunacy in late year-s was only an apparent
The clay of her admniissioni
shl e hadi several fits, increase,and that there is no proof statistically that there is a larger
nosy. following andd

eveningg hadl a successio)n o)f seseral fits from P. to M. The 7

proportion of actual insanity in the populationi noy than theere was
noticeable pioints in the fits w ere : Violenit rbytIbmical mo-ement thirty years since.

the head fromw side to sidle, to the numiiber of one lundired minulte,
U ;niiauae-ai Convulsions a, d1iiep ding n/

attendied by a peculiar slioit piration, like a bark ; Tlonic sc) ibed lesion of Ceci-ebralConvoluti.ins. By BYROM BRAMWLLL,
of the muscles of the limbs, we-er-
which Strongly flexed spasmws M.LB., Newcastle-on-Tyne.-Mary Conway, aged 37, was admitted
about three minuutes exten(iing the trunk,ulltimately
to and duCiDg to hospital M\ay 23rd, 1875. Eightshe received a
years ag,o,
actuial opisthotonos; 3. Increasing congestioni of neck
severe blow on the left side of the head.
(The skull was fractured.)
until, at the maximum of the spasms, the face assumed Three years ago, she had four right-sided unilateral convulsions,
epileptic lividity, with complete closure of the glottis
; when, brought Fior the past three years, she had
oni, shie thought, by fright.
choking seemieed iiimineint, sudden relaxation took place, felt " pins and needles" in the forefinger and thumb of the right hand,
stertor, blow,ving respii-ation, aud foaming at the mouth
; and had not been able to use herneedlle as well as formerly. MIay
On
fits had lasted some time, the right foot was observed ioth, she went to bed very drunk, and vomited all the following day.
contracted during the spasms; and by the morning it
On May i ith, she had a severe convulsion, and continued to have fits.
distorted similar to the left one. She became maniacal A week after the fits commenced, "she lost the power of her right arm
days, with fits at intervals. During one series and leg". She looked fifty years of age. The pupils were equal,
 .276 THE BRITISH MEDICAL 70URN4L. [August 28, 1875.
moderately contracted. Boths eyeballs wvere turned upwards and to the families, which were related, there lbad been previous mental weakness
left. She lay on her right side. The eyes were partly closed. She and a tendency to phthisis. Tbe mother gave an account of a severe
was unable to move the right arm and leg. Wlhen the mouth wvas nervous shock sustainied by her about the miiddle of pregniancy, owing
opened, it wvas drawn to the left sidle. She could not protrtsde the to her witnessing the fall upon his head of one of her other children.
tongue, -which was abraded at its tip and on the right side. Slie swal- The author, -while stating his gelneral disbelief in the influe)ce assigned
lowed well; her appetite sas good. Slhe was conscious, anid could say by ml-others to such impressions, arg,ued that in this case the malforma-
several wvords; knexv her name and address. Iler speech wxas thick, tion of the head 55 as at least as likely to result from that cauise, as from
and difficult to understand. Slhe could imperfectly localise impressiols. the more scientific onle assigned by Virchow in similar cases of prema-
She made nio complainit of pain when pricked xvith a needle. Muscular ture ossification, to which the rickety diathesis would not be likely to
contractility and sensibility seemcd natural on the two sides. Every contribute. He remarked, further, that the essentially lhumiian charac-
fexv minutes, she was seized with a convulsion. There were thsree de- teristics of both the cases lent nio support to the theory of Vogt as to
grees of severity. In the fisst or slight form, the muscles of the face the pithecoid affinities of microceplhales.
and neck w-ere alone affected, in the following manner. Both eyes Bulbar Par alysis. By T. S. DoWSE, M. D., I-lighgate.-The author
were first firmiily closed, anid the right corner of the mliouth wxas (lrawvn first raised ani objection to the French name glosso-laryngeal paralvsis,
downwards in tosxic spasm, and the eyes ere next partly oplencd ; the and hoped that the German term bulbar paralysis would supersede it,
head anid cyeballs w-ere then slowly tssrned to the riaht side. Clonic because it was shorter, anid gave a more definite idea of the extent
spasms next occurred in the eyelids (the left being only slightly af- of the lesion in the medulla oblongaata. lIe drew attenitioni to the
fected), the muscles of the tonrgue, right side of the neck, chiefly the etiology, clinical features, diagnosis, prognosis, pathology, and treat-
platysma. After a short iiiterval, the clonic spasms became much less menit of the disease. Dr. Dowse's practice in the Cenitral Lon(do
frequent. The head anid eyeballs were slowly turnied to the mi(ddle Sick Asylum had given him considerable experienice in this as iu
line; the eyelids wvidely opened ; and the patient presented an animated kindrecd diseases of the nervouis system, and1, inllopposition to the opiilions
appearaince. The eyeballs were finally turnied upwards ancd to the of most writers on this subject, he held that the so-called bulbar para-
right; the eyelids x-ei-c closed, anid the patient lay apparently asleep. lysis, although essenitially progressi% e anl(l surely fattal, mighlt be (livid(ed
In the secosicd form, the convulsioni conmmelsced as before; btut the right into two classes, (Iir-ect anid inidirect. The (direct arose from-I. P-o
arm anid leg were atfected (us a definiite order, not here detaile(l). In gressixe interstitial nlleuitis; 2. Thrombosis of medtillary vessels; 3.
the third formii, the fit ecut oni as in the first and seconid forms, anid then Hxmorrhage; 4. 'Morbid growths; 5. Spasm of vessels. 'T'he in-
became genieral; the lefl side being affected in a definiite order. The directarosefrom-i. Reflexaction from peripheral irritation; 2. In-
slight fits occurred every fev sninutes. The optic disc was large and hibition from shock to the central cerebral ganglia. Of these varieties,
pale, in conitrast to the surrounding fundus, xvhich wxas highly injected. only one could be consicdered to come unider the term slowly progressive
There was a depressioln in the skuLll twxxo isnches above the left ear. the others he looked upon as retrogressive and stationary. Ile detailed
The diagnosis xvas actite softeninig, either from embolislmi or irritatiosn the clinical notes of a case of paralysis of the facial, hypoglossal,
beloxv the point of depressioni. The trcatment consisted isa the applica- spinsal accessory, and glosso-pharyngeal nerves, where speecd anid miiove-
tion of coki to the head, bromide of potassium, and inourishment. She ment of the tongtte had been lost for more than four years, and wlvhieli
died somewhlat suddenily oni May 30th. At the aost ma;o- tern examina- w as cured by the continuous galvanic currient. Ile also (gave the clini-
tion eight liours after dleatlh, there xvas fosn(d to be a perforation of the cal iiotes of a case of retrogressive paralysis of the bulbar nerv es,
skull at the point of depressioss. A sharp spiculum of bone projected which, in his opinion, was of a reflex nature. Dr. Dowvse didinot be-
from the issuier susrface of the skull, and(1 pressed Uponi the cerebral con- lieve in reflex paralysis of the hypoglossal nerve from diphtheria,
volutiosis, causinig a very limited lesion of the isaferior margin of the neither did he recognise an hysterical bulbar paralysis of a plersistent
ascending parietal conv'oluttion. There vas some softening at this part character. Dr. 1)ow se dcrew attentioni to one point, which lhe con-
and below it. The brain xvas otherwise healthy. The membranes sidered of great importance in treatment, andI gave a case wNhese the
vere generally opaque and thickened. Dr. Bramxvell remarked that man so far recovered as to resume his occupation of a coal-heaver,
the imposrtant points of the case wvere: I. The long lapse of time betxveei through the early admiiinistration of fluid nourislhment by means of a
the receipt of the injury and coivtslsions ; the convulssions occturrisig for piece of elastic tubing passed through the nostril. He said that it w as
a single day, and theni being ussilatesal ; tlse nismbness in the forefinger unjustifiable to trust a patient to feed himself unitil the disease was so
and thuml) of the right ha-md for tlai-ee years: 2. The remarlable uni- far advanced that he w as liable to choke himself with every mouthful
formity of the order in wlhich the asarious muscles wvere affected by of food. Artificial feeding was absolutely necessary immediately the
spasms: 3. The limited lesiosi found after death 4. lhe fact that the second stage of deglutition became affected. Driugs wvere of little value.
general coiivulsions were controlled by bromide of potassium. The The adiministratioln of steel and cod-liver oil was indicated, anld the in-
case seemeld to confirm some of Dr. Ferrier's experiments, provisng that jectioni of one-fortieth of a graini of atropine inito the submaxillary
the centre for the platysina is the same in man alnlI the lower aniimals. region hlad in some instances checked the overflow of saliva.
It also conifirmed the sounsdness of Dr. Hughlings Jackson's views onl On t he El/t/c/s of 1Vti; jiols Diseases oan t/e fei-gl/ (X)- tile .Se-e-al Pa,-/s
epilepsy (disclxarging lesion of the cerebral colavolutions). It w-as diffi- qft/i EnZueephahlaa, ili 2,050 Sane andl Jitsa7ize A4dults ij _ba// .Se^rs. B3y
cult to say xvhat as the exciting cauise of this attack ; possibly the R1. 13oyl), M. D., London. -The paper w as foulnded oln the results of the
violeiit vomlitisng. Ise exact cause of death Nvas not ascertained (the necrological registers kept by Dr. Bo)yd durinig tllih ty years in the
head alone could be exalxiined). There wvas a decided rise in the tem- St. Marylebone Infirmary anid ini the Somerset Coutmty Luniatic Asylum.
perature of the rigist si(le. RigDr mortis came on carly (eight lhours As regards the sexes, it was founid that the average weight of the
after deatll) in the riglat side, but not in the left. The bone was not encephalon was from four to five ounces heavier in miiales than in
trephined. It must, however, be remembered that the patient xvas females, and that there was a dlifference inl heiglht of anl clual inumber
recoveriilg. lIlere was no true apimasia. of iniches. The proportions of the differenit parts of the enceplhalosi,
7,wo CCases !f J/ic;-ccct9yhlic Ialiac)j. By G. E. SslUTTLEwORTHI, estimated accordling- to the heighlt in 400 males and 325 females,
MI.D., Lancaster..-The autthor gave a hsrief description of the physical insane, wvere as folloxvs: the average hligihlt in the malcs being 66
and mental cliaracteristics of txv-o microcepisalic idiots now' resident in inches, alnd in the feniales 62 inclhes.
the Royal Albert Asylum, Lanicaster. Remarking that the case of one AMale. Female.
of thenm hadc been alrea(ly referrcd to ill tise last e(lition of " 13ltcknill Cerebrum (rig;ht hemispihere) .301 .294
and Tuke", lie proceeded to compare the presenit hlead-measurements , (left ,, ) . 302 .295
and characteristics of tlhat patient wviti time accoutst then quoted fi-om Cerebellum. .77 .076
Dr. Irelasnd's observatioss ill I871. lIe statedc tlhat, whereas at that Poins and medulla .oI6 .oI6
(late the circumferenice of tie boy's head xvas bust 14' ilnches, it x-as nosy Encephalon. .697 .6S I
14I inches ; and that othier measuremeiats sioxwedl that there ilad been The cerebrutm was .007 heavier in males tlhan- in females, and the left
development during the last four years, chiefly of the posterior part of fhemisplherc wvas heavier than the right by .OOI in botlh sexes; thle
the skull. The boy, lao x-as eleven years old, -%vas actix-e, observant, cerebellum .OOI heavier inl males ; the polis anid medulla alike in thlc
and displayed e-en evidlence of capacity to carry on a train of reason- two sexes ; the enicephalon oI6 heavier in males tlhaln in females.
ing. Tlhe etiology of this case wmas obescure. The second case describedi Inequalities in the size of the tv(-o cerebral hemisipheres bave firequently
Avas that of a boy agedi 7, xhlsose lhea(d Ineasired onlv I4-l incahes in cirlcuil- been observed, especially in epileptics. (See MAoica-C'hii,ll'Oicil
ference. TIle vault of tise slkull xvas of fair proportiolls, anld, ill fact, time 7;)xinsaclie/ias, vol. xxxix.) Ti lie heaviest brains have oftenl heen those
headi simply seeme(I to be formedi ous a s-ery small scale. lIhc chikld liad of epilcptic idiots; hypertroplhy of the connecting tissue has been folun(d
a full lustrotis eve and fairly intelligent appearance; and, though pos- in them; to the same cause may probably be attributed convulsions
sessing but feeble powxers of expressing himself, wvas very observant and and sudden death in apparently healthy children, cases of which are in
inquisitive. He was of rickety diathesis, the child of parents in whose the registers referred to in the Marylebone Infirmary. Of the 2,050
 Augtust 28,I 1875.] TH-E BRITISH MEDICAL _OURNAL. 277
- -
.

cases, 6i6 males and 653 females Avere sane, and 430 males and 351 effect following the dose which had been so much lauded by various
females insane. Fromii the comparative table of the effects of various writers. Then, again, his experiments as to the quieting properties of
diteases on the wveight of the brain, in the sane and the insane of both morphia in cases of mania were ceitainly neither more hopeful nor
sexes, it appeared tlhat, taking the total numbers, the encephalon was more satisfactory than those connected with melancholia. In nearly
heaviest in the inisane, the difference beinig in the males three-fourtlhs every case, indeed, he found that the dose took away the appetite of
of an ounce, and in the femiales an ounce anid a quarter. he average the patient; and for this reasonl he did not consider morphia so bene-
weights ivere as follow ,s taken from the wlhole of the cases: ficial as bromide of potassium and other remedies. In regard to the
Sanc. Insane. mere sleep-producing effect of the morphia, he thought the chief objec-
14. F. A1. F. tions to it were the dryness of the mouth that wvas apt to be experi-
Cerebrtum . 41.4 36.4 4I.8 37-5 enced in the morning, and the excitement occasionally brought on
Ccrebelluim . 5-I 4.6 5.4 4.7 instead of sleep. On the whole, the results of his experiments in rela-
l'ons and mclulla . I.0 1.0 0.9 I.0 tion to the action of morphia on insane patienits ere such that he had
w

Encephalon . , * 47.5 4I.9 48.2 43.2 almost universally discontinued its use.-Dr. MCDIARMIID pointed out
Tables were then given, showing the average xveights in diseases of the that the results spoken of by Dr. Clouston might be attributed to the
nervous system, pullmioniary diseases, cardiac diseases anid dropsy, ab- fact, that that gentlemain had administered about tlhree times as much
doomiial diseases, anid typhus. Diseases of the nervous system were morphia as had been done in the experiments which he lhad conducted.
most niumerous amonigst the inisane males, amouniting to nearly 47 per Exape-i;nn/ts onz the B1-aist (of MAonkeys, lith/ esjL'cial Retfi-eence /o t/e
ceiit. of their wvhole numiber ; this excess wvas due to the frequency Loc(alisation of Sensor Ceti/-res it the Convolutionts. By DAvID FERRI1sR,
of general paralysis, a disease, as the syiiiptomns inidicate, usually M4. D., London.-The experiments on which the following conclusions
accompanied by softeniing and sometimes by induration of the spinal are based were supplementary to those of the electrical irritation of the
cord as stated by Dr. B3oyd in I848, confirmed by the miiicroscopical brain of monkeys, already publislhed in the P'rocceedintgs cf /le Roytal So-
observatioius of AMr. GLutlliver, ancd since by other observers. The ciety. They w%ere recorded in detail in the Croonian Lecture read
eniceplhalon was 23' oubcesbelow the average wveight. In pulmonary before the lRoyal Society in May last. In the abscence of Dr. Ferrier,
diseases, the encephalon as below the average weight inimales anld
w Dr. Lauder Brunton gave a brief summary of the miiaini results. The
inisane femiiales. cardliac diseases, the cenceplialon was considerably
in method followed w,vas the comparison of the effects of electrical irri-
above the axverage weight in all classes, also in abdominial diseases, tation with those folloWing localised destructioni of parts of the br-aini
except in saue miiales, ini whom it was the avcrage weight. In fevers, by means of the actual cautei y or scalpel. The two sets of experiments
too, the encephalon as above the average xveight, so that cerebral supported and explained eaclh otlher. The most important fact demoii-
vasting seems to accompany chlronic diseases, cerebral and pulmonary. strated by this series of experiments was the localisation of regionis of
ThZC Psc/volcogy ({f [itZscle. By J. S. NAIRNE, L.F.P.S., Glasgoxv. special sense in the convolutions; and this, alonig ith localisation
w of
-According to the autlhor of this paper, man has a psychologic and a centres of motion proper, served to clear up the true signiificance of the
pneumatologic niatuire. The latter is hidden. MIuscle is entirely re- reactions to electrical stimnulation. I. Destructioni of the frontal re-
sponsible for the formner; aixi( the idenitity of the nervc-centres witlh gions of the brain, which gives no reaction to electrical stimulation, is
muscle, i.e., as muscle is asseltedi. The psychologic plhenomiena are without effect on sensation or volulntary motioni, but clauses marked im-
vital anid initellectuial ; the poxers ar-e sensory anl motor ; anid con- pairment of intelligence and of the faculty of attention. 2. Destruction
sciouisniess is an attiil)ibte of muscle, but not necessarily of it alone. of the grey matter of the convolutions bounding the fissuire of Rolando
This consciousniess is progres-ssixe xvith organ, and at last amounts to causes paralysis of voluntary motion on the opposite si(le of the body,
knowledge. The senses are the highest muscular organs of knox- sensation remaining unaffected; while lesions circuimscribed to areas,
ledge, and beyond thelm and xvithout them there is no remembering previously localised by the author, caused paralysis of voluntary
perceptive poxver. The beinig, the phenomena, the poxvers, are in all motion limited to the muscular actioln excited by electrical stimulation
cases the resLIlt and necessity of deiinite equilibrium; without xvhich of the same regions. 3. Destruction of the anaular gyrus causes
equilibrium there is nothill,. blindness of the opposite eye, the other scnses and voluntary motion
being uniaffected. This blindniess is only of temporary duration, pro-
vided the angular gyrus of the opposite lhemisphere remains intact.
T'lheif t -mi fnj(' tJ)ng f fioy5/iao in hisoni,ty. By J. AWIhen both are destroyed, the loss of visual percel)tion is total and per-
McDLAicMi1i), M4. B., A\Ilurthly.-After somiie preliminary remarks, the manient. 4. Destruction of the superior temporo-sphenioidal convolu-
author spoke of the super iority of the hypodiermic to the stomacliic adi- tions abolishes conscious reaction to auditory stimiiuli, the other senses
uxinistrationi of morphia. The physiological reasolns w-ere the greater and voluntary motion remainiing unaffected. The restults of destrllc-
exactness of the dose, the easy administration in rebellious patients, tion, taken wvith the effects of electrical stimulation of this region, indi-
amid the unaniimous conisenit of experimenters. Thle usefulness of hypo- cate that it is the centre of auditory perception. 5. Destruction of the
(lermic injection of morphia in insanity was commented on, and its use hippocampus major and hippocampal convolutioni abolislhes the sense
ini melancholia, acute mania, recuLrrent mania, chronic mania, ailid general of totuch on the opposite sicle of the body. 6. Destruction of the
paralysis xvas illustrated by cases. The habits of filthy dememlts xvere suibicutlutlmz coi-nu aiomooslnis, takeni wvitlh the results of electrical stimula-
improved udndler the hypodermic treatment. There xvas delayed action in tion, indicates that this is the seat of the sense of smell for the same side
somie patients. Constipation x-as Ilot catused by this method of giving of the bodly. 7. Destruction of the grey matter of the lower pait of
morphia. Vomitiing after subcutaneous injection xvas not frequent. the tempom-sphenoidal lobe in immiiediate relation to the region of
Ilypo(ler-mic iiijectioln of morphia xvas unsuitable in maniacs suffer- olfactory perceptioln abolishes the sense of taste. 8. D)estruction of the
immg fiomii heartL-lisease, aild xas to be employed only as a (dte-niel- optic thalamus causes complete ancxsthesia of the opposite side of the
x-'sso;-t. The uise of atropia in coombiniationi xith morplhia subcu- body. 9. Ablation of the occipital lobes prodtuces nlo effect on the
tamleotusly xxas descril)ed ; anid also the doses of morphia requiired in special senses or on the powers of voluntary motion, but is followed by
the various formiis of insxanity. The results obtained by this miiethod a state of depression, with refuisal of food, niot to be accounted for by
xvere comiipared xvith those of cannabis Idllica, chlioral, bromxiide of mere constitutional disturbance. In one case, which survived the
potassium, anld opitiill an(d miorphia by the mouth.--Dr. Ci,ousiroN operationi for three weeks andI was then killed, the appetite returned: a
(Edinburglh) said the effects of miiorphia in cases of insanity might be phenomenon probably to be accounited for by compensatory associa-
dividedl into three classes: fi-st, xvhat might be called its specific effect on tion. The sexuial appetite, however, wvas exhibited(l during the first
miielanicholia; secondlly, its (quietinig effect imx cases of mania; amld thirdly, few days after the operatioin, as judged by the behaviour of the animal
its sleep-producilg eflect ini all cases. In regard to the first of these- to a companioni monkey. IO. Ablation both of frontal and occipital
the specific action of imiorplhia in melaicliolia-he performed a nlumber lobes in one monkey did niot interfere with the powers of sensation or
of experiments some years ag-o, treating the patienits ith morplhia, and of voluntary motion.-Dr. R0oERErsoN (Glasgow) thouglht those ex-
adminiisterinlg doses of fiom half a grain to two grains. Duril)g the perimflemnts, thotulgh doubtless very interesting, should niot lead us too
progress of lis experimemxts, behad xexighecd the patieiits every week, hastily to conclusions, as Dr. Ferrier's observatioins wvere miuch dis-
ladl taken the temperatuire of their bo(lies, aui(i ha(l their (liet carefully puted, and the monkey's braini w^as not the same as a mani's.-Dr.
atteicdledi to. Ile di(u Ilot a(diixiliister the morphlia hypodilrmically; but SAUNDPvY refer-red to Veyssiere's experiments oni the localisationiof
he stupposed tlhat, so fa, as its special effect melaltliholia ixxas con- commoni senisibility.-Dr. Dui,uy (Paris) gave the resnilts of his oxvn
oii

cerned, tlIat xas of little accoulmt. Tahe restult of his observatiomxs xvas observations, which differed from those of fr. Ferrier.--Dr. CATON
not in accori(aice wvitll those of McDiarmidi. Of txventy-twvo (Liver-pool) had repeated maniy of those experimenits, anid could confirm
I)r.

patients xvith wvhomlhe hlad experimented, the great nmajority lost Dr. Fierrier's statements. He had only just been made aware that Dr.
weight during the treatnxeiit, xxhile the appetite at the same time seemed Ferrier had been doing anything to localise special sense, and was very
to diminish. In only three of the cases wvas there anythiixg like that pleased to find that the centre, assigned by Dr. Ferrier to the sense of
 278 THE BRITISH MEDICAL _70URA 4L. f fAuzust
-r-Auut 28,
8--I i874.
sight, was one wvhich he liad localisedl by an entirely different method, BEVERIIDG,, 1M.D., Abtrdeen.-The death of this man occurred
viz., that of
noting the variations in the electrical currents of the brain almost immediately after his first descent for the season. There waas
as caused
by ftunictional exercise.-Dr. FRASER anid Dr. STMITII fol- no defect in the apparatus, and his companioni wvlho descended with him
lowed, an(d the latter e\pressed the genieral sense of the meeting in unaffected ; it could not, therefore, be (ine to deficienit suppl)y of
was

thanking Dr. Lauder Biruniitoni for ably explaining Dr. Ferrier's views. air. Oni a previous occasioni, this man ha(l, under similar circuim-
stances, neatly lost his life. It also wras his fir-st drescent for the season.
F.-PHIYSIOLOGV. It w-as tusual for divers on (lescen(linig for the first time to experience a
S; ITION feclinig of oppression and a senisationi as if the lheadl would burst. 'T his,
1'rlslnes atl', A ut," USt 4th. as a r-ule, passed very quickly away, ai(l nothing fuLrthelr w-as olbserved
DR.
RDONX S ANDEI ts0N, F.R.S., President, toolk the Clhair at 2 in the wvay of discomfort till after leavinig the Nvater, when there w\as
B

P.M-A.
of' the Ion<t'
veiy ofteni a sensation of giddiness, sometimiies an attack of sickness,
7h7ansfirenCe
the Iunler-ots in Choi
7n(l/on o/ the Pie/Zt scle fi-o;;i the Sea- and in maniy cases a flow of blood from the nose and mouth. Most
s

t/u/a and- Disease of the S/iozul/ler. By JoIIN feiv tr-ials became accustomed to the work anid suffer-ed nio
to
after men a
S RUtJIIERS, M. D., Ab)tldean.-Dr. Strutliers
explainied hlow the inconveniience, but some did niot do so, and always suffered in some
tendon, say in a rhentmiiatic shoulder-, being nio longer of any tuse, was way on leaving the water. Th'liese symptomis wvere uinidoubtedly due to
removedl froim the tlipper bone and joined to the lower bone, by oti
the varying pressure on the vessels oni the luings, anid in the above case
vhich use w-as
its
tlhercby to some extenit preserved. The steps of this had prodLicedI complete stoppage of the pulmiioniary circulation. 'T'his
process narratedl, subject was further elucidated by the view wNas coniLrmed by the post moreteiz examination. Th'lie heart as
were and the
exhibition specimenis. Adhering to the lowver bone by the effects of large, pale, and flabby; its cavities wvere empty of hlood* the lunlgs vere
of

excited action, the part of the tendon withini the joint, having become initenisely gorgedl with dark flitid blood. The air-ttubes, beginlning at
fttnctionless, was seen in i-arious stages of passing away, wlhile the thle fauces, w,ere muclh congested, dark purple in colour; and the smallei
attachment of the lowrer bones, on w%vhich the intiscle pulled, became bronchli were partially fille(d witlh (lark frotlhy blood. Other organs
gradually stronger till the adaptation s-as completed. Dr. Struthers were also loadled with (lark b)l1o(o. The heavy pressure (in this case
that this niiii-ht be called a
remarked
)athological process ; but patho- doublled) WoLnI catuse partial stoppage of the lung-circulation, throNviig
logical processes were also physiological processes; and, lie expected back the venous 1)lood0 oil the right sidle of the hleart, and thlus inducing
that
fttture, the sttu(ly of these processes wvotld throw- much light on
in
insensibility and suffocationi, wvhile the quick takinig off of the pressure
questions conttectedl with the origin an(l adaptation of healthy struc- coulcl allow all those vessels to fiil to the utmiiost, thtus producing the
tures. great gorginig of all the bronchial surface, and the complete emptying
Exe5e-ioicnts ont Chanoe of thle Bo(dily Teic-ltature consequent on See- of the cavities of the heart.-Ini the discussioni that ensued, several
Co;-d in the Cer-vical Region.
tioiz
oJ the
By BURDON SANDI)ERSON, gentlemiien expressed dloulbts as to the cause of the man's death, sug-
.

M.D., LL.D., F.R.S., London.

The Elect;ii Currents
gestinig that, although one of the diving-bells was safe, the other mighlt
(:f the B-ain. B3y RICIIARD CATON, MN.D., niot have been so, and that this might not have been ascertained on
Liverpool.-After btief r'muni;i of previous investigations, the author account of the connecting-tube being out of order.
a

gave an accounit of his owNn expetiments on the brainis of the rabbit

and the
monkey. The summary of the principal
follow ing is a brief 7T1hz,-sWay,, Augu,st 5th.
results. In every braiti hitlterto examined, the galvanometer
has in- Ph'ysiobl,ical Acoustics. By J. G. MCKENDRIC Ml.D., Edinburglh.
K,
dicate(l the
The
existetice of electric external surface of the
currents. -DLr. McKendrick gave a (lemonstration on plhysiological acoustics,
,grey matter is usually positive iin relation- to the surface of a section with the vieNv of illustrating the results of the researclhes of Helmnholtz
throtugli it. Feeble cuirr-ents of varying direction pass throtigl the regarding the (quality of mtisical sounds. After pointing out that
multiplier when the electrodes are place(l oti two points of the external Ilelmlboltz had dliscovered that a musical note consisted, not of one
strface, or one electrode oti the grey matter-, an(d oltc onl the surface
of the skull.
tone, uttt of a series of tonles, l)r. IcKendrick procee(led to slhosv this
The electric currents of the
grey tiiatter appear to have by means-s of ani ingenious contrivance devised by l)r. Kxoenig of Paris.
a relationi to its function. When aniy part of the grey matter is in In a scries of initeresting- expCrien-lrts, it Nvas shonvil liow a tonie could
a state of funictional acti-ity, its electric cturrent utsually cxhiiits nega- be dlecoml)osed, as it were, inito its fuLndamental h.armoies, and in this
tive variationi. For example,
the areas shown by Dr. Ferrier to be
oti
way ani actual flame-pictture of it be obtained.
relatedl to rotation of the head anid to mastication, negative variation of 14Lct of Division of thze Sympathetic Ae7-ve cf) the' 1vck in Y'oun0i, Azni-
the currenit was observ ed to occttr whenever those twio acts
respectively vIals. By VI LLIAIM STIRLING, D.Sc., M.D., Edinburgh. --lr. Stir-ling
were
performed. Imiipressions
through the selnses wvere foutnd to itifltlence said that the division of the sympathetic nerve in the neck, for inistance,
the currenits of certain areas; g., the currents of that part of the
e.
of a young rabbit dog was, in the first place, followed by the ordinary
or
rabbit's braiti
w,vhich Dr. Ferrier as shown to be relatedi to movements symptoms of the operation. As the animiial grew, however, it wvas
of the
eyeli(ls, ai-ere foun(d to be markedlly influtencedi by stimttlation of foundc that the ear of the side in wvhich the nerve wvas dividedi grew
the
opposite retina by lig-ht. more thaln that oni the other side. The hair of the ear ttpoI this side
7Te Di<,gestive Pr-inciple of Insectivorous Plants. By LAWN-SON TAIT, became stronger than on the opposite side; anid, lastly, the tempera-
F. R. C. S.
Ed., Birmitigham.--Mr. Tlait cotmiiunicated the results of cer- ture of the aftected part continiued higher than that of the other side for
tain
experiments lie had made, for the pulpose separating the diges-
of several months together.
tive
princil)le or
fermenit, oli w
hich the remarkable power possessed by Anatomlly a71(1 Physiology t he Semici-cular- Canals. By A. CrUM-
certaiti planits, as
pointedl out in MIr. Darwin's recenit
interestinig work, BROWN,NT1ALD., Efdinburgh.--The nmaini object of the paper was to
is depetideint. Mlr. Tait slhowed
possible to separate this
that it was elucidate the theor-y that these canals may afford our senise of equi-
priticiple fi-omii platit experimental purposes.
the for As to the precise librium and rotation. After stating the convictioln that wve possess a
method of its
actioii, he was still etigage(l in inq(juiry; btlt, so far as his sense of rotationi quite distinct from all our other sensrs, Dr. Crum-
researches hadl gone, lie was able to confirm the view- taken by Darwin, Brown piroceededl to show that this sense must niecessarily have a
that the chemical p rocesses concernied in animal and platit digestion
Nvere idenitical.
sp)ecial
totation.
lpriplheral organ physically constituted so as to be affected by
Thle structure of the scemiicircuilar canals of the internal car
Thze Efticts of cer'ain Drit-g n/au the anial Circlation.
By J.liitcac; w;as, lhe considered, such as to fit them to act as stuch a peripheral
Al. FOT-It RGIL , M.DI).,
LIolidon.-Dr. Fothiergill state(d that, ill pro- organ ; anid this view was sulpp)orted by the experiments of Flourens
dltcing effects upon tie ititracranial vascularity, there were two factors aind (oltz. The bony canals in qtiestion being filled with liquiid, rota-
(I) direct effect Ut)Ot1 the circulatory system ; andI (2) an effect upon
a
tioIn of the head about ani axis at righlit angles to the planie of a canal
the cerebral cells
by w hich they attractedl more blood, or less l)lood to would prodluce motion of the contents, and this might be expected to
themselves. These factors existed in
varyinig proportions in. differeilt irritate the terminiations of the nerves in the amppulla.
druigs ; and accot-ding to the exigencies of each case, onie or other agent Ont Injetion of the Ai7(lnte' in7 Bright's Disease, in Reelatfihn to Albu-
should be chosen, as
opitum ill cases of insomnia from pails, clsloral- minm-ina and ZIicnzaturia. 1By J. COATS, I.D., Glasgow.
hydrate rather wheti the sleeplessness takes its oritgin in a high blood- A histological Pi-ocess for- Staining Tissues. 13y FRANCES
pressure. Whether the agetit adlminiisteredI (lepl)e.sses or stitiulates the Ei tZABt'rit IIOGGAN, M.D., Lorndon.-AIrs. Hoggan said that the
nerve-centres, its
actioun can usually be ititeinsifie(l by giving it along
process in question recommended itself principally on account of the
with drugs which act
(lirectly
upon the circulation, as
opiumll wvith atiti-
property it possessed of staining the substance of the cell as well as the
mony, and
quinine, which affects the encephalic blood-vessels ; with nucleus and nucleolus, anid because it gave the best results where car-
digitalis, which
blood-pressure genefally.
raises the minmate of ammonia failed. It consisted in first pouring over the
On a Case of fro-m SuCffocation in a Diver, illustrating some specimen (after treating it with water and with methylated spirit) a
Erects of Ine-reased Pressure ont the Pulmonary CiYcu/lationi. By r. one-per-cent. solution of perchloride of iron; and, in a few minutes
 August 28, 1875.1 THE BRITISh MEDICAL 7OURNAL.
afterwards, a few drops of a two-per-cent. solution of pyrogallic acid--
both solutions being mande in distilled water. A practical demonstra-
tion of the process was givern by -Mrs. lioggan.
The Action of Siim/lants ircotos. nBy fiioIOMs P. LuciAs,
L.R.C.l.Ed., Lonclon.-This papvr opened wimith a notice of nervc-
force. The author expressed the opinion that vitality is dependent upon
an exhibition of this force. -e iadduced several proofs to show that
it is most closely allied to electricity, and dlesignated it as nervo-elec-
tricity. He divided tlmis nervo-electricity into three parts: (i) that with
which the nerve-fibres, muscles, and tissues generally are always
charged, and which is spent in the ri-or mortis-the residuhal ; (2) the
radiant nervo-clectricitv, or that which is continuously pasitug fromt the
body with the eliminated heat-the complementary (3) that which is
called forth and discha-ueA in lie shlihition of every vital plieinoirenons-
the supplementars eervo-electiicitt. The second portion of the paper
was devoted to a notice of -the action of dliugs on the cerebro-spinal
and sympathetic neer.es, in order to show that stimulants act through
the formei, and natcotics by means of the latter. A num-iber of proofs
were adduce(l to show the action of narcotics upon the sympathetic.
Instances ws-ere gi en to prol-c. that stimulation (narcotisation) of the sym-
pathetic induces generaireal t tin, contraction of the blood-vessels,
and congection of the cpi'll -ties, a-sd consequent coma and deathl. On
the other hand, evc-e sutimlation (narcotisation) paralyses the sympa-
thetic ; the rseuit of wich is th-'t the cerebro-spinal exercise their
powers unchecked, and more or less prolonged rigidity of the mluscles
ensues. A--ill, thus-c miedicilos woich stlimulate the cerebro-spinal
(stimulants), cause itocteased actis ty in the l)arts stimulated but if
pushed to a treat rlct e, they exiaust, and, by a provision of nature,
narcotisation sets in * if the stimulation he still further pushed, exhaus-
tion of the vital organs takes place, and death is instantaneous. In
conclusion, the paper vent to show that, by watching the action of
drugs upon animals, by pushing thie trial to the extreme limits, and by
noting the ptst mort-em alppearances, we could ascertain the nerves on
which such drugs act. Thus, in disea.se, we should be able to apply
remedies in a scientific manner, not by an imaginary law of sibmilia
similibits cn-tur-a-, but by a demonstrated law, contrtaria conltrariis
surantmti-.
i'idty,) August 61/i.
The Zn/hen/an-c iJ Lerons Lesions. By Euc-LNn Duru-, 'M.D.,
Paris.
Capillar-ies in thme Umbilical Co;-d. By LAwsoN TAIT, F. R.C.S.,
Birmingham.
Demonstratioam of tien Al-tted of UP)g te-ce ing 1i atomne. By
W. RUTHERFORD, M.D., F. R. S., Edinlb-urgh.
The MaJgnetic Conditions (of Arte-ial and 1'nolts Blood considered inl
relation to the inilence t1/at Arteirial Blood exr^ts in ,miromotinto tihe
Fuinctions of Life; anzi the consequent Value of Jltatnetismn as a, Tic-,'fa-
peutic Agt. By R. C. SIIETTLE, M.D., Readin.-In this paper,
the author referred to the experiments lhe had brought before the Royal
Society, in which lhe had demonstrated the fact that a grand distinction
exists in the physical properties of arterial and venous blood with
regard to magnetism, atid that the magnetic properties of arterial
blood are dependent upois the oxygen absorbed in the blood, with the
amount of which they are in direct proportion. I-le 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 actionl, and as by another law the amrount
of electric force generated is in direct relation with the amount of
magnetic disturbance, it follows that, if the arterial bloo)( is able to
sustain life by virtue of the chemical action of oxygen, it is equally
able to perform the samie work by virtue of the magnetic disturbance
to which the motion of the corpuscles gives rise; and, inasmuch as
magnetic influences are exerted at sensil)Ie distances, and chemical
action depends upon the contact of bodies, it also followed that in
these operations of life chemical acLion must be secotndary to and
directed by magnetic action. Hle 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 kingdoim result: I. From the food upon
which the animal lives; and 2. From its habits of life ; and, inasmuch
as they result 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 regar( to health, every form of matter taken into
the system baying its ownN specific magnetic influence: I. Over the
blood-corpuscles; and 2. Through1 them ov-er the nerve-currents ; dis-
order or disease resulting from the imperfect manner in -which organic
principles are formed and combined either fromn insufficiency of force
or impurity of matter acted upon. With regard to the treatment of
disease by medicines, lhe showed by the above law that, as a rule, all
clrugs 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 miagnetic character of the 1)loo10, so inducing more
powerful currents of electricity in the nerves. AIagnetic bands applied
externally are frequently of the greatest service, either alone or in
conjunction witlh internal remcdies, as they increase the polar influ-
ence of the part over wihich theey 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
Nvhich must necessarily be as unknown as they are mysterious). With
reference to the theological bearing of the -subject, lhe showed that
the fact of vital activity being referred to magnetic action only testified
to the simplicity and unity of purpose which pervadles all the works of
the Creator, the grandeur of wihich becomes anparent not only in tlse
phenomenea of terrestrial magnetism, but also in the application of the
samie force to all the phenomlenla of life.
ComJoibzaCve By/i(U-/IZCOI/. BY JANM S Ross, AL. D., Waterfoot,
Manchester.
A u11i'CZs g IP;-,vroztiuzo Deal/s (drling' I/e Exth-acliols of Teeths 1s,11el
Chl'orofoi-vs. By T. LAUDER BRUNTON, M.I)., F.R.S., London.
SELECTIONS FROM JOURNALS.
MIDWIFERY AND DISEASES OF WOMEN.
TIleT UNMIANAGEABLE VOMI1TINGS OF PREGNANCY.-The _7our-nal
de lit'eciJne el ti C/zhhwt-u,:rie quotes a communication from M. Tarnier
resj)ecting a case in which, in a multipara in the third month of preg-
nancy, serious unmanageable vomitings wvere arrested lby the simple
application of a plug of wadding to the vagina. He collates with this
fact three cases published in the BRITISH MEDICAL JOURNAL, ill
which 1)r. 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-
monstrate(l to Dr. Copemain that dilatation had a great influence on the
arrest of the vomitings. Pregnancy went on in due course, and the
patient was delivered 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
vomithigs 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 Lj'on
IL'dical, 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 preveitts the twitchings or distension of the internal orifice.
PATHOLOGY.
AMALFOR(MATION oF, AlimoMI NAT, ORGANS.-R. \iinsche describes,
in the eighth volume of the 7zYarbmchl fiir K sle/i eilkunde, new series, a
case of congenital occlusion of the pylorus, with occlusion of the duo-
denum at its passage into the jejunumn, 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 WVirsung 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.-Centralblall
fair die AMedicin. TVissensch., May i8th, I875.