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spring of 1866, cholera acquired an increased diffusiveness ;and by June had attacked many places in the UnitedKingdom, but hardly any cases occurred in London untilJuly. [The Suez Canal was opened in November, 1869.]Extension of cholera from Northern Arabia was next

threatened in 1871 ; and the disease prevailed to a smallextent in Europe during 1872 and 1873. Since that date, ithas occurred several times among the pilgrims to the Holyplaces, but has not established itself in Egypt, nor has itprevailed in Europe. Cholera is now at Damietta, a placewith some 30,000 inhabitants, about six miles from themouth of one of the branches of the Nile. The way of itsarrival thither cannot be stated. Damietta is not on anyhigh road from Asia ; and the towns above Damietta on theNde are not known to have been affected before this town.No cholera is known of at Suez, nor in the course of theCanal, though from Port Said an occasional death is nowbeing reported. In the ten days ending last Saturday, about500 deaths from cholera occurred at Damietta ; on July lstthere were 140; on the 2nd, 130; and on the 3rd, yesterday,there were 110 deaths. The disease now exists at Mansourah,higher up the same branch of the Nile, and cases are appearingin other towns situated on the railwavs of the Delta.

2. Expctatid;:=’ijh,- I have been asked, may cholera’be expected to travel through Europe to England ? how longafter its present manifestations in Egypt ? Evidently nomedical data exist for an answer to the question. We doact understand all the conditions for the diffusion of thedisease. But we in England do firmly believe, what manyof our Indian friends would deny, that cholera is influencedin its spread by human intercourse. We do not affirm thatit passes from person to person as small-pox or typhus does ;but we believe that it extends much after the fashion withwhich we are familiar in the case of enteric fever, by meansof the discharges from the sick, particularly if those dis-charges are received into foul cesspools and drains, or if theyobtain admission into drinking water; and human inter-course is one of the conditions for the spread of cholera insuch fashion as this. If we now, for the sake of hypothesis,suppose other conditions for diffusion of cholera to be to-daywhat they were in 1865, we may inquire how far the condi-tions of human intercourse have altered in such wise as toaffect the probable dissemination and rate of transmission ofcholera in and about Europe. In reply, let it be rememberedthat, though Egypt has doubtless incurred repeated riskfrom her communications with the Hedjaz, there is no.evidence that even Egypt has been subjected to dan-ger from cholera, at any time, through her directmaritime communications with more Eastern countries;let it be remembered that the Suez Canal has now been-open for more than thirteen years ; and let it furtherbe noted that the present outbreak of cholera in Egyptis not on the line of traffic between Asia and Europe ;and it will appear improbable, I think, that the use of thenew highway will affect the course of cholera towards Franceand England. Still, it is not to be supposed that 1883 will- .fiud us in every respect under the same conditions of humanintercourse as 1865; and it is possible that some of thechanged conditions may be such as to affect the opportunitiesfor the migration of cholera. But, plainly, they are notworth speculating about, in view of our complete uncertaintywhether those conditions for the diffusion of cholera whichare independent of human intercourse are or are not to bethe same in 1883 as in 1865.

3. Precautions.-" Quarantine," meaning by the word asystem which professes to prevent the entry into a countryof persons coming from another country until assurance isattained that no infection can be introduced by those persons,is not now regarded as capable of fulfilling its pretensions ;and its least failure to exclude infection is seen to make thewhole system irrational ; its cost and its vexations unjusti-fiable. Accordingly, England, which long ago abandonedthe system as of any avail against cholera, has now the con-sent 6f most European nations (as expressed by their dele-gates to the Vienna Conference of 1874) in preferring for thedefence of her ports another system which, under the name.of " medical inspection," aims at obtaining the seclusion ofactually infected persons, and the disinfection of ships andof articles that may have received infection from the sick.The details of this system, as formulated for practical appli-cation in the ports and waters of England, are set forth inan Order of the Local Government Board of July 17th, 1873.Provision is there made for the detention of ships at appointedplaces ; for the visiting and medical examination of ships

and passengers ; for the removal to hospital of personssuffering from cholera or suspected cholera, and for theirdetention there ; for the speedy burial of the dead ; for thedisinfection or destruction of clothing and bedding ; and forthe purification of the ship and of articles therein. Thisorder is at present operative. From a statement by EarlGranville last night, I learn that it is proposed to reissuethe order, though without change in essentials. It repre-sents the system upon which we rely, in preference to qua-rantine, for the protection of our shores. For the last tenyears the country has been thus prepared for the invasion ofcholera, and the fact of this preparedness should be known.We have reason to hope that if cholera should enter Englandit will find fewer opportunities for doing mischief than atprevious invasions. We are generally better provided with

: defences against a disease which spreads as cholera can. spread. Some further precautions for use at the moment; will doubtless be requisite ; but it will be on our permanent; sanitary works and procedure that we shall with most con-, fidence rely.

ACADEMY OF MEDICINE IN IRELAND.

Spontaneous Dislocation of the Hip.-Spinal Injury andMuscular Atrophy.

AT a meeting of the Surgical Section held on March 9th,Mr. KENDAL FRANKS read a communication on Spon-taneous Dislocation of the Hip, illustrated by two caseswhich he had himself observed, and of which casts wereexhibited. A child, aged five, was admitted into the Ade-laide Hospital in January last. She had been confined tobed since the summer of 1882, suffering from "acute disease ofthe left hip-joint." The acetabulum had chiefly suffered, andthe head of the femur had probably passed partially throughit, and in that position anchylosis had taken place. Anabscess which had formed burst into the vagina, and healedup. The limb remained permanently fixed in a semi-flexedposition, abducted and rotated outwards. The child hadbeen chiefly lying on this side, the right leg flexed, ad-ducted, and rotated outwards, so that the knee lay behindthe knee of the diseased limb. In August last, as she wasbeing turned in bed by the nurse, a remarkable protu.berance was seen behind the right anterior superior spine ofthe ilium. The child was questioned about it, but could notgive any account of how it occurred. It gave rise to no pain.This protuberance was caused by the great trochanter, thehead of the right femur having slipped out of its socket, andbeing easily felt on the dorsum of the ilium. No alterationin the parts has since taken place. The second case illus-trated a dislocation of the hip, taking place during an attackof acute rheumatism. A girl, aged fifteen, was admittedinto the Adelaide Hospital on Oct. 10th last, suffering fromnecrosis of the left tibia. She presented a well-marked dis-location of the right femur on to the dorsum of the ilium,the limb being shortened to the extent of 3 in. In May,1879, she had an attack of acute rheumatism, from whichshe completely recovered. In the following February-thatis, two years ago-she was attacked again with the samedisease, which kept her in bed for ten weeks. The righthip-joint and the right shoulder were the parts chieflyaffected. To alleviate the pain pillows were placed underthe hip and knees. When she tried to get out of bed afterthe disease had subsided, she found the right limb consider-ably shortened, so that she could only reach the ground withthe ball of the foot. The right hip was deformed, and shenow presents all the characteristic signs of a well-markeddislocation. The head and neck of the bone can be easilyidentified in their new position, and feel quite smooth andhealthy.-Mr. STOKES instanced a remarkable case formerlyunder his care in the Richmond Hospital, in which a fallwas apparently the exciting cause. The patient fell downstairs, sustaining a very severe injury, but he did not applyfor advice till a fortnight had elapsed, when it was found hehad sustained a dislocation on the dorsum of the ilium, whichwas, with very little difficulty, reduced by manipulation. Nextday, dislocation again occurred, and was reduced; but luxa-tion recurred three or four days in succession. He suggestedin explanation that the fracture of the rim of the acetabulumhad taken place originally, and a portion of the bone wasdriven away from its normal situation at the time theluxation recurred.—Mr. BEXXETT thought that too much

importance was attached to the term "spontaneous." All

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pathological dislocations were spontaneous. A more im-portant division would be as to whether the dislocationswere complete or incomplete. The term "spontaneous" "

was a mistake for want of observation. In the deformity inquestion he would not be surprised if the bones were stillintact, but altered in shape.-Mr. FRANKS, in reference toMr. Bennett’s criticism of nomenclature, confessed he hadhad difficulty in choosing a title for his paper. Perhaps itwould have been better had he described the dislocations assimple spontaneous dislocations to distinguish them fromdisease of the articular surface. He agreed, however, withMalgaigne, that the best line of distinction to draw wasbetween dislocations due to simple relaxation of the liga-ments without any disease of the ends of the bone, andcases in which there was caries or some other disease on thehead of the bone. Dislocations that occurred from distensionof the ligaments formed a distinct group.

Dr. R. McDoNNELL brought before the section notes ofthree cases of Injury of the Spine, followed by ProgressiveMuscular Atrophy. In all three cases there was little, ifany, loss of sensibility. The patient was sensitive to tactileand thermic impressions. The wasting of the muscles wasrapid and set in early after the injuries. The character andappearance, as well as the marked degree in which indi-vidual muscles were attacked, showed, in the author’sopinion, that muscular atrophy in these cases dependedupon the same causes which produce individual muscularatrophy in infantile paralysis and paralysis of the Duchenne-Arun type-viz., myelitis affecting the large motor nerve cellsin the anterior cornua of the spinal cord.-The PRESIDENTinquired what were the conditions present in the case thatrecovered.-Dr. SWAN, referring to the same case, askedthe author if he believed that there was regeneration of thecells in the anterior horns.-Mr. WHEELER mentioned awell-known case that was in the City of Dublin Hospital,under the care of Professor Purser, suffering from Cruveilhier’spalsy. The patient was a tall gaunt man, who used to standat Baggot-street Bridge, and had been driver of the Wick-low coach. His upper extremities were only held to histrunk by ths levator anguli scapulae muscles, so that theposterior superior angles of his scapulse were pulled up closeto his ears. He stood with his body thrown forwards, toprevent his abdominal viscera from falling forwards, as allthe abdominal muscles had disappeared. The palsyapparently originated from injury. He fell and hurtthe back of his neck and spine. From the cast shownby Dr. McDonnell it seemed that the flexor brevis ab-ductor and opponens pollicis muscles were very muchwasted. He asked, could Dr. McDonnell assign anyreason why the flexor ulnaris muscle and other muscles werenot wasted in the same proportion, and if he had made obser-vations in similar cases of the condition of the nerves downthe forearm whether their motor fibres were altered. Withregard to Dr. McDonnell’s second case, it appeared to him(Mr. Wheeler) that the trophic cells were not engaged, butonly the connective tissue elements, and when it returnedto its normal condition the temporary influence it exercisedon the cells ceased. -Dr. McDoNNELL, answering Mr.Wheeler, first as to how the particular muscles atrophied,said in all of those that belonged to the group he was speak-ing of it commenced in the spinal cord. If a group of thosecells disappeared, it might be laid down as certain that themuscle corresponding with that group of cells would alsodisappear, and the nerves leading to that would witheraway In those cases which he had examined the nerve-fibres in the roots were found to be atrophied. The questionwas naturally asked, "Might it not begin in the muscle ?

"

or, as Cruveilhier put it, in the nerve-root, or in the trophiccells ? Years ago he had himself asked Lockhart Clarke ifhe had had opportunity of examining cases in which, longafter amputations, those cells had not been called into use,and whether for want of use they had become atrophied.It appeared that in fifty or sixty cases which he had ex-amined in Greenwich Hospital the cells in the spinal cordwere found to be right. Evidence had been accumulated toshow that the disease really began in the nerve-cells andspinal cord.

BEQUESTS AND DONATIONS TO MEDICAL CHARITIES.Miss Agnes Ellis, late of Newcastle-on-Tyne, bequeathed£ 100 to the Infirmary of that town.-The Royal Hospital forIncurables receives £ 100 under the will of the late Mrs.Sarah Brown, of Upper Berkeley.street.

Reviews and Notices of Books.A System of Surgery, Theoretical and Practical, in Treatises

byvariousAuthors. Edited byT. HOLMES, M.A. Cantab.,Surgeon to St. George’s Hospital; and J. W. HULKE,F.R.S., Surgeon to the Middlesex Hospital, and to theRoyal London Ophthalmic Hospital. In Three Yols.Third Edition. London: Longmans, Green, and Co.1883.

THE issue of a new edition of "Holmes’s System ofSurgery" is an important and welcome event. It has longbeen recognised as the authoritative exposition of the Britishschool of surgery, and the twelve years which have elapsedsince the last edition was published have been so rich inresults, both in surgical practice and pathological doctrine,that much in that edition has already become antiquated.Important changes are to be observed in this edition. Firstand foremost among these we must rank the association ofMr. Hulke with Mr. Holmes, in the work of editing. We needhardly say that this is a valuable acquisition to the editorialdepartment, and that no happier choice could have beenmade; for Mr. Hulke combines in a remarkable degree a.

large personal experience with wide reading and extendedscientific acquirements. Another alteration is the publicationof the work in a cheaper form : the five volumes have beencondensed into three, not so much by lessening the lengthof the various essays, or by the exclusion of essays, as bythe use of thinner paper, pages of a larger size, and a smallertype. Bibliophiles will regard this change as a retrogression,but as it will place the book within the reach of a larger circle.of readers it has our hearty approval. A period of twelveyears has unfortunately necessitated many changes in theauthorship of the essays. In some cases the writers for the

previous edition are no longer among us, while in othersthey have associated themselves with younger men, whohave re-edited their essays; while in a few instances

they have stepped aside altogether, and handed over theentire task to others. Speaking generally, we may saythat this edition is of considerable value to the student and

practitioner. In every part it bears evidence of most painstaking study and revision, and while in some few cases therestraints of joint authorship and joint responsibility may betraceable, on the whole it is a worthy exposition of thebeliefs and practice of British surgeons.The first volume comprises nearly all the essays contained

in the first and second volumes of the previous edition. It

opens with M. Simon’s article on Inflammation, edited byMr. Holmes, and Dr. Burdon Sanderson’s article on the

Pathology of Inflammation immediately follows, which has.been rewritten and most carefully brought up to date, so thatit forms a very valuable introduction to the whole work.Mr. Butlin has rewritten Mr. Holmes Coote’s article on

Abscess, and the chapter on Tumours and Cancers previouslyprepared by Sir J. Paget and Mr. C. H. Moore, and he haaalso edited Sir J. Paget’s article on Ulcers. Mr. Butlin has,of course, considerably modified the article on Tumours inaccordance with our increased knowledge of the intimatepathology of these growths, and he has introduced severalwoodcuts of his own microscopical preparations of many ofthe chief varieties of tumours. Mr. Cripps has edited butnot altered Sir J. Paget’s article on Sinus and Fistula, andhas furnished one on Gangrene in place of that by the lateMr. Holmes Coote. Mr. Holmes has revised the lateMr. De Morgan’s article on Erysipelas, and Mr. Clutton haswritten that on Pyemia, including Septicsemia, which waspreviously from the pen of the late Mr. Callender. Mr. Crofthas revised his article on Hectic and Traumatic Fever, and theTreatment of cases after Operation, and has also revised Sir J.Paget’s articles on Contusions and Wounds. Mr. Hulke hasrevised Mr. Poland’s article on Tetanus. Mr. Warrington