852 " HYDROPHOBIA AND RABIES."

scarcely be an appreciable difference, if any, between

the outer air and the drain air. In fact, he reduce,the house-drains to the position of simple conduits tc

carry easily away and conceal from the eye and nose

matters offensive for the moment to the senses of sight andsmell, but otherwise practically open-air passages. This

is the culmination of science and practice in this importantmatter, and the highest testimony to its value is afforded bythe fact that Mr. FIELD’S method of proeedure is substantiallyadopted in the Model Bye-laws as to house-drainage forthe use of Sanitary Authorities lately issued by the LocalGovernment Board, and will thus, it is to be presumed,become the common practice of the kingdom.

Annotations."Ne quid nimis."

"HYDROPHOBIA AND RABIES."

SIR THOMAS WATSON has opportunely contributed a useful chapter to the literature of hydrophobia by his paper iithe current number of The Nineteenth Century. The viewi

propounded are not new, although they are set forth with thjfreshness and grace of this classic medical writer’s vivie

and elegant diction. What remained to be said, for thl

public, has now been said, and so well that nothing need bladded. Upon the lines of this article, with the able expositorJstatements placed before the community by Sir William GullSir Joseph Fayrer, Inspector-General Balfour, and otheiauthorities in the columns of THE LANCET, the student—professional or lay-may pursue this grimly popular subject tcthe limits of actual knowledge, and other contributiOn!which have appeared in our own columns will carry him

as far as it is safe to go into the region of speculation andconjecture. In respect to one matter, upon which we ven-tured to offer a suggestion in a leading article last week, byway of explanation of the supposed long periods of incuba.tion or latency, Sir Thomas Watson propounds the sametheory, remarking that he first broached the view fortyyears ago, 11 but I do not know that it has been (to use abarbarous modern term) endorsed by any of my professionalbrethren." In a foot-note he adds, 11 find that Dr.

Anthony Todd Thompson, in the thirteenth volume of the6 1VIedico-Chirurgical Transactions,’ 1826, has been tiresomeenough to forestall me in this suggestion." May we bepermitted to follow suit, although it involves a confession ofignorance or forgetfulness, and protest that we had nonotion the hypothesis had been submitted before it ap-peared in the leader pages of THE LANCET. The circumstanceis of no moment beyond the curious illustration afforded ofthe difficulty which exists of making a novel refaction onthis worn subject. It is, therefore, no disparagement of theservice rendered by the paper in The Nineteenth Cent2vry tosay that its story and teaching will not strike the medicalreader as new. The principal recommendations are two,one for general, the other personal action. Sir ThomasWatson gives the sanction of his authority to a proposalwhich originated with Mr. Youatt, and has been supportedby Sir James Bardsley-viz., to place all dogs in this countryin quarantine for a period of seven months with a view toextirpate the disease rabies, of which hydrophobia is thecounterpart in the human subject. We fear the proposalis scarcely practical, but, if possible, it might be tried.In any case much good would, doubtless, be accomplishedby the owners of domestic animals being made legally

responsible for their care, and bestowing closer atten.tion on their wants and maladies. The other sugges-tion to which it is desirable to allude is the recom.mendation that when a person is bitten he should

instantly apply a ligature firmly above the wound, and striveto work the poison out by pouring water upon the bite froma height. This is not suggested instead of more effectivemeasures, but as a precautionary proceeding which may beuseful when the circumstances admit of its adoption.Regarded in that light it is worthy of consideration.We do not share the fear expressed by Sir ThomasWatson that grave danger would attend the expedi-ent of sucking the wound, except in cases where there

may be an abrasion of the lips or mouth. This point,however-the possibility of absorption "through" themucous membrane when intact-needs to be further in-

vestigated. We would only urge that disastrous results,rarely ever, if indeed they have been known to, follow thefamiliar use of suction by the mouth in the case of woundspoisoned by snakes, arrows, or decaying animal matter inthe dissection room. The contents of the mouth are in-

stantly discharged, and bad effects have not, so far as weare aware, been known to discredit the practice. Wecommend Sir Thomas Watson’s paper to the perusal of ourreaders.

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"TRUTH" ON "THE ’UNSPEAKABLE’ STAG."A CONTEMPORARY which claims to hold the mirror up to

nature, law, and fact-social and political-has stigmatised inno measured terms some remarks we recently offered on thesubject of "Tame Stag Hunting." The rejoinder is madein an article of considerable prolixity, one-half of which isdevoted to the defence of fox-hunting—a a sport we havenot impugned. Phrases so familiar as "Is Saul also

among the prophets?" "Will wonders never cease?" "Thisis an age of heterodoxy," 11 Sir Oracle speaks," 11 let the

cobbler stick to his last," do duty for pleasantries.What may be lacking in argument is substituted byabuse, a little coarse, and somewhat undiscriminating.Regarded from an artistic point of view, the effort is not asuccess. We regret this circumstance, because, whenattacked, it is pleasant to feel the onslaught has been under-taken with weapons and an address worthy of the occasion.Here and there our assailant makes a point-as, for example,in the witticism about "men whose vocation and pleasure itis to live with < Lancets’ in their pockets;" albeit we seemto have heard something of the kind before, and there is anaphorism credited to Johnson concerning the class of clever-ness for which credit may be claimed. Meanwhile there is

absolutely no trace of reasoning, no new ground advanced,or old argument refurbished, in apology for the practice wedenounced. If there had been anything to urge on behalfof tame stag tormenting, so diligent and expert an advocateas the champion who has now entered the lists would surelydiscover and expound it. The only consideration whichthrows doubt on this presumption is the circumstance thatour censor does not perceive the difference between a

genuine tu quoque and the broadcasting of an im-

putation which has nothing in common with the chargesto be repelled. We are counselled to "write no moreabout hunting;" "Let those who live in glass housesbeware how they throw stones." Tame stag hunting mustnot be denounced because these self-sufficient gentlemenwho again call attention to the perilous character ofthe < amusement which involves needless brutality,’ are,

forsooth, the doctors, who, at this moment, are on theirtrial before the public, charged with the crime of vivi-

section" ! An authority so independent as Truth shouldnot fail to recognise the wide distinction which exists

853

between the crazy allegations of a few fanatics and

public opinion. There can be no hesitation in affirmingthat the judgment of intelligent common-sense has not

been against " the doctors" in the matter of vivi-section ; but if it had been otherwise this would be noreason why we should refrain from speaking the truthabout the wanton cruelty of chasing tame deer for the solesake of a pastime miscalled sport! The investigations pur-sued in the name of science have always had a scientific, and,in a restricted sense perhaps, a humane object. We havenever disguised our opinion that experiments on the livinganimal ought to be limited to cases in which there is likelyto be an immediate gain, and that in every instance where Ithe circumstances admit of its use, a full anaesthetic should ’,be employed. Possibly, the new method of "mixed narcosis"may enable the exceptions to be reduced to a minimum ; butwe only allude to this question of 11 vivisection " incidentallyto clear away an irrelevant matter which has been importedinto the present controversy with the obvious purpose ofcreating a diversion from a known weak point. Again wesay our appeal is to real sportsmen, not to the pretentiousand self-appointed champions of a practice they do notapparently understand. We have no fear of being mistakenby those to whom we speak.

PERSISTENCE OF BRANCHIAL FISSURES.

THE gains to be derived from the study of morphologyreceived an apt illustration in the paper communicated tothe Royal Medical and Chirurgical Society by Sir JamesPaget, and in the discussion that ensued upon the readingof the paper. Not only does the knowledge of develop-mental processes throw light on many hitherto unexplaineddefects and seeming aberrations of structure, but, as

pointed out by Sir James, the very defect itself may indicatean inherent weakness in a region, rendering it more pronesubsequently to become the seat of actual morbid changes;and the field thus opened is practically boundless. Thereis also a peculiar fascination about the subject, due to thediscovery of vestigial relics of what, in the normal courseof development, are transitory and fleeting structures, thatadds greatly to the interest with which it is pursued. The

paper in question was not limited simply to the subject ofthe occurrence of defects in the external ear ascribed to theretention of parts of the first post-oral branchial fissure,but opened up the whole question of the occurrence ofbranchial fistu]Ee in man. At the risk of wearisome repeti-tion, we may glance again at the ground covered by thispaper. In the mammalian embryo, at the fourth week,there are, on each side of the head behind the oral cavity,four clefts, or fissures, communicating with the anterior ex-tremity of the alimentary canal, having been formed fromwithin outwards by a process of absorption. They arehomologous with the more numerous clefts in the bran-chiate vertebrata. By the sixth week the third and fourthof these fissures have disappeared, and by the ninth weekthe first alone remains, and this persists throughout thewhole of life, being converted into the external auditorymeatus, tympanic cavity, and Eustachian tube. Im-

portant structures are, however, developed in the foldsbetween the clefts-the branchial arches; so that, in spiteof the change in form produced by the developmentof the neck, the original situation of the clefts may, byreference to these structures, be always indicated. Thefirst arch is that in which Meckel’s cartilage is formed,and around which the mandible is subsequently developed,whilst nearer the base of the skull the malleus completesthis mandibular arch. Between this and the second 01

hyoid arch comes the first post-oral cleft, which alone per-sists throughout the whole of life. In the hyoid arch are

developed the styloid process, the stylo-hyoid ligament,the lesser cornu of the hyoid bone, and the incus of theear, the stapes and the stapedius muscle being connectedwith it. The third arch is represented by the great cornuand the body of the hyoid bone, whilst the fourth leaves nopermanent structure to mark its early site. Occasionallythe clefts between these arches remain more or less patent,and the recognition of this fact not only explains the occur-rence of congenital nstulse in the neck, but also of cysts inthe same regions, and of diverticula from the pharynx orcasophagus. The formation of the external ear is subservientto that of the first post-oral cleft; it is an integumentaloperculum or fold, and Sir James Paget suggested that thecurious instances of 11 supernumerary auricles " were doubt-less similar formations in strict serial homology with theauricle of the ear, and that therefore they are probably foldsconnected with branchial fissures beyond the first. Now thatattention has been so prominently drawn to th subject, wemay hope for further investigations, and especially in thedirection of the development of these opercular folds andtheir relation to the branchial fissures. Until we have thisadditional knowledge, it must be confessed that it is not

quite easy to see how the first post-oral fissure, persistingnormally as the auditory passages in the cases related, shouldbe prolonged upon the integumentary fold, which is formedsubsequently to the formation of the cleft. Upon the solu-tion of this depends the question as to whether the con-genital fistnlous tracks on the pinna, undoubted arrests ofdevelopment as they are, C’1,n in due strictness be styledvestiges of the branchial fissure itself.

THE LONDON SMALL-POX EPIDEMIC.

RECENT weekly returns of the Registrar-General affordundoubted evidence of a recurring wave of the small-poxepidemic in London, especially in the east group of districts.The fatal cases of small-pox registered in tke metropolis,which had been 9, 25, 14, and 27 in the four preceding weeks,further rose to 31 in the week ending the 1st instant. Of

, these 12 occurred in the Metropolitan Asylum Hospitals,; 4 in the Highga.te Small-pox Hospital, and no less than 15, in private dwellings, almost invariably under circumstances, rendering home isolation a manifest impossibility. Four-I teen of the deceased small-pox patients (including those, who died in hospital) had resided in EMb London, of whom! 7 belonged to Stepney, 5 to Mile-end Old Town, 1 to Poplar,

and 1 to Shoreditch. The 7 fatal Stepney cases included! 5 in hospital and 2 in Limehouse. Of the 5 in Mile-end Old

, Town only 1 was recorded in hospital, and the Registrar-, General calls attention to the fact that of 14 fatal cases. there registered daring the four weeks ending the 1stl instant, only 3 OCCllr&iuml;r6d in hospital isolation. This failureJ of the local sanitary authority to adopt the only known suc-- cessful method of checking the spread of small-pox among aL population which includes a considerable proportion of im-c perfectly vaccinated persons, calls for investigation. The

medical certificates relating to fatal sma,ll-pox cases con-r tinue to give (except in hospital cases) very little informa-. tion as to vaccination. Of the 31 fatal cases registered last3 week, 10 were certified as unvaccinated and 9 as vaccinated$3 while in the 12 other cases the certificates gave no informa-t tion as to vaccination.

r The number of small-pox patients in the MetropolitanAsylum Hospitals steadily increased during the nine weeks

, ending the 1st instant from 137 to 256, and during the last,

of thosa weeks 54 new cases were admitted, against 58 ands 78 in the two previous weeks. The Highgate Small-poxr Hospital contained 19 patients on the 1st instant.- In the outer ring of 8ubnrban districts around Londonfour fatal cases of small-pox were registered last week, of

854

which two occurred in West Ham, one in Chigwell sub-district, and one in Kilburn. The deaths from small-pox inthe outer ring in the two preceding weeks had been five andsix. The fatal case at Kilburn last week was of a child

aged two years and ten months, at Stanmore-terrace, whowas said to have been vaccinated two years ago, but whobore no visible marks. It would be interesting to know onwhat evidence the statement that the child had been vac-cinated was based. Setting aside the fact of the child’sdying of "small-pox, semi-confluent, seven days," the factthat the child bore no vaccination marks is conclusive thatit could not have been " successfully" vaccinated withintwo years. It is a striking fact that at every recent ex-amination of the vaccination marks of children in the

metropolitan elementary schools the proportion of suc-

cessfully vaccinated children is very far below the proportionoriginally certified as successfully vaccinated. Surely thisstate of things calls for careful inquiry, as true vaccinationis thereby discredited.

Small-pox is just now unusually quiescent in all thetwenty largest English towns, except London. During thelast fortnight of November only two fatal cases of small-poxoccurred in the nineteen provincial towns (having a popu-lation of about three millions and a half of persons), ofwhich one was registered in Liverpool and one in Birming-ham.

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VOLUNTEER AMBULANCE SERVICE.

THE introductory lecture of the series which we intimatedin our issue of the 10th ult. was about to be delivered bySurgeon-Major Staples, A.M.D., to the members of theVolunteer Sick-Bearers’ Association, came off on Friday, the.23rd ult., at the Society of Arts. We regret that’we cannotspeak of it in those terms of commendation which we wouldhave been pleased to employ. Mr. Staples began by takingexception to the title of the association, and in this we agreewith him; but his suggestion of " Volunteer AmbulanceDepartment" seems equally exceptionable. Why not call itvolunteer ambulance corps or company, if it is not to beformed into a body distinct from the regiments which furnishthe men composing it ? After noticing the advantage whichwould arise from a connexion with the medical department ofthe regular army, and illustrating this by a supposedtransport of this portion of our home defensive force acrossthe Channel, the lecturer proceeded to give a brief and super-ficial sketch of the medical field-service of the armies ofhistoric Greece and of Rome. Passing rapidly over themiddle ages, he brought under notice the reforms effected inthe French army by Barons Larrey and Percy in the end ofthe last and beginning of the present century, and wound upwith a brief and very imperfect sketch of the ambulancesystem of our own army down to the termination of theCrimean campaign.We cannot but think that the evening might have been

more profitably employed in pointing out the nature of theduties required or the means at present employed in ourservice. We trust that Mr. Staples, having thus gonethrough the historical portion, will in future confine himselfto the practical. The subject is one of so much importance,and there is so much valuable instruction needed, that we

- feel thoroughly provoked at such a misuse of time.In an exhaustive work on the subject, such as Professor

Longmore’s 11 Treatise on Ambulances," it is necessary totrace their history at different periods and in different

countries, but this is quite uncalled for in a course of lec-tures addressed to volunteers with a view to their instructionin the duties which they may be expected to perform, andthe most efficient mode of affording aid to the wounded inthe field. We trust Mr. Staples will not lose sight of this in

his succeeding lectures, and we cannot point out to him abetter example of always keeping the practical object inview than Professor Longmore’s book, the title of which wehave just quoted. ____

THE NATIONAL HOSPITAL FOR THE PARALYSEDAND EPILEPTIC.

WE are glad to hear that the board of this hospital havedetermined upon the erection of a new and commodious out-

patient department, for it was time that some serious step wastaken to remedy what was fast becoming a grave difficulty.The number of out-patients is now so large that the waiting-room, which met the demand twelve years ago, has longceased to be an adequate provision for the patients and theirfriends. Epileptics and paralytics can rarely, as comparedwith patients suffering from other disorders, make their wayto and from the hospital unattended by some companion, andhence there is demand for space in a greater ratio than iscustomary. Moreover, the occurrence of an epileptic attackin a room thickly crowded with persons prone to similarseizures, is an event which not only must be expected, butwhich practically, as we are informed, never fails to occuron every day that out-patients are seen at the hospital. The

present waiting-room, being low, cannot be satisfactorilyventilated. It has no retiring-rooms of easy access from itinto which a patient could be rapidly removed out of sightof those to whom of all persons such an exhibition is un-desirable. The sufferer therefore lies in the midst of thecrowd till he recovers. The physicians have only one con-sulting-room, so that there is much delay and inconvenienceattending the examination of patients, who, as in the caseof paralytics, frequently need, on account of their helpless-ness, to be undressed by the attendants. There should ofcourse be examination-rooms where this could be donewithout interrupting the work of the physician.

It seems that the board have acquired in the rear, and bythe side of the existing hospital, space which representsnearly four times as much as that now occupied by the out-patient department, and upon this they propose, if the fundsare forthcoming, to build a new waiting-hall, consulting-and examination-rooms, and, indeed, every requirement forcarrying on the important work with as little discomfort aspossible to the sick and those who bestow the gift of valuabletime in the investigation and relief of their ailments.We do not doubt that the money necessary for the purpose

will soon be provided, for the hospital has always met withvery generous support. From an economical point of viewalone, the out-patient department is an important feature ofthe institution. There are large numbers of epileptic patientswho attend the hospital and are thus enabled to continuetheir occupations and support their families. Except formedical treatment they would necessarily, in very manycases, become a burden upon the rates.

HOSPITAL STATISTICS.

ON another page will be found two interesting tables ofhospital statistics, one from the Newcastle-upon-Tyne In-firmary, the other from the Azamgarh Dispensary in theNorth-West Provinces of India. The latter is interesting asa record of what is being done to bestow upon the nativesof India the blessings of civilised surgical and medicalskill, but the former table will perhaps possess a widerinterest for most persons as illustrative of an importantphase of modern surgical art. Fifty-nine major operationsor serious injuries, with only six deaths, or 10.17 per cent.,is a result that certainly speaks well both for the surgeonsand the Infirmary. But what may be termed the pre-ventable mortality was even less than 10’17 per cent. Acase of primary amputation through the hip-joint died four

855

hours afterwards from shock; an excision of the hip-jointin a patient aged fif ty-two years proved fatal from extensivebladder disease; and a caee of ovariotomy died eight daysafter the operation from enteritis, although the wound inthe abdominal wall had healed by first intention. Theresult is, we repeat, on the whole gratifying, but it has adark aspect as well as a bright one. We are toldthat Lister’s antiseptic plan of dressing was followedin every case to which it was applicable ; but it isadded that "secondary haemorrhage, after the applica-tion of the catgut ligature, was markedly frequent."This latter statement furnishes material for very grave con-sideration. There is evidently a growing distrust of cat-

gut ligatures. Later trials seem to confirm the experienceof former years that animal ligatures cannot always betrusted to support the walls of an artery, until the repara-tive processes are sufficiently far advanced to obviate therisks of secondary hmmorrhage. Hopes were cherishedthat the improvements which Mr. Lister and others haveeffected in the mode of preparing the catgut ligature, andin the way of applying it, would remove the objections thatbelonged to the earlier forms of catgut ligatures; butrecent disclosures have shown that these hopes have beenbut imperfectly realised. The discussion at the last meet-

ing of the Clinical Society, and the statistical return fromthe Newcastle Infirmary, point but too strongly in thisdirection.

___

THE ARTISANS’ DWELLINCS ACT.

THE West of England is quickly following the lead ofLondon and Birmingham in adopting this beneficial Act,for the Town Councils of both Exeter and Devonport havepassed resolutions to apply it at once to the most crowdedand unhealthy portions of these boroughs, and the in-habitants of Plymouth and Bristol are beginning to inquireif they had not better do likewise. It has been determinedat Exeter to pull down a " rookery " called Sherman’s-court,in the west quarter of the city, between Stepcote-hill andPreston-street. These streets will be widened, and a suffi-

cient area be left to build new houses for the accommodationof a number of persons equal to those who will be dis-lodged-namely, 108 adults and 136 children, who nowoccupy 149 rooms. It is probable that the Industrial

Dwellings Company, which has already erected three largeblocks of buildings in the most populous parts of Exeter,will take the site, and carry out the improvement, now thatthe authorities have determined to use their powers of

purchase under the Act. The doomed area in Devonport islarger, for 133 houses will be pulled down, and 903 inha.bitants displaced. Nearly all the houses in Dockwall-

street, James-street West, James-street, and Catherine-street, with the alleys and courts adjacent, are unfit foihuman habitation, and furnish such a large proportion ojdeaths compared with those of Devonport generally, that ncbetter part of the borough could be chosen for beginningsuch a valuable improvement. For the past ten years, thEmortality in this district has averaged 304 per 1000, whilslthat of Devonport, excluding the above area, has been 19 9In some years, as in 1871 and 1872, more than twice thEnumber of people have died here in proportion to othe]parts of the borough. Sir John St. Aubyn, who is the largesowner of property in Devonport, will carry out the schemeand provide new houses, suitable for a working-class population, in sufficient number for the accommodation of thosiwho will be temporarily dislodged, besides such new streetas may be arranged between him and the corporation. W,

hope that no opposition to the carrying out of these twgreat improvements will be made in Parliament, an

earnestly urge on the authorities of other towns, in whic]

similar unhealthy and crowded localities exist, to follow, asquickly as possible, in the same path.

TWO CASES OF DOUBLE DISTAL UQATUREFOR INNOMINATE ANEURISM.

ON Thursday afternoon last, at Charing-cross Hospital,Mr. Barwell ligatured, under antiseptic precautions, thecommon carotid and the third part of the subclavianarteries on the right side in two cases of innominateaneurism. The first patient was a delicate-looking womanabout thirty-five years of age who had an aneurism, promi-nent and pulsating, just below the inner end of the rightclavicle. Nitrous oxide gas was respired for a few minutes,and ansesthesia completed by the inhalation of ether. Mr.Barwell then tied the right common carotid artery with acatgut ligature, which was cut short; after which thewound was drawn together with silver sutures, and dressedantiseptically. The subclavian artery on the same side wasthen dexterously and rapidly tied with catgut, and thewound closed. The second case was that of a man agedforty-six, who had been a soldier, and in whom therewas a syphilitic history. This case was altogether moreserious than the preceding one. The aneurismal sac

was very large, and extended into the root of the neck. Thesternal end of the clavicle was pushed upwards and forwards,and strong pulsation could be felt under the lower attach-ments of the sterno-mastoid muscle. An&aelig;sthesia was pro-duced by the same means as in the former case, and theright common carotid artery was secured with catgut; but,

: in consequence of the great prominence of the clavicle, the. subclavian artery lay very deep, and there was some diffi-

culty and delay in getting the needle round it; this, how-ever, was eventually accomplished by paesing the needle

- from above downwards, pulsation at the wrist ceasing im-. mediately and completely when the ligature was drawn

tight., Mr. Barwell has had three cases of this nature within at few weeks. A report of the first case will be found in THE- LANCET for November 17th.

-

. POISONINC BY CHLOROFORM.

A DEATH during the inhalation of chloroform, preparatory1 to undergoing an operation, has occurred in a village near

Llanelly, South Wales. The patient, a collier, twenty-nine, years of age, in fairly good health, suffered from fistula int ano, for which Messrs. Buckley and Thomas, surgeons,f determined to operate. After inhaling the anaesthetic for

s a few minutes, the patient became suddenly blanched in- the face, and breathed feebly, and in spite of the endeavours- of the surgeons, who persevered for an hour in performing- artificial respiration, died. The autopsy revealed a hyper-r trophied condition of the heart, and at the subsequent in-f quest the jury returned a verdict of 11 Accidental death,o during the administration of chloroform."

Another case, in which recovery occurred, is reported :-Ae patient took in the morning, about half-past eleven, onet ounce of pure chloroform in some coffee. He was called

about a quarter of an hour after ; he replied he was sleepye and wished to lie in bed. The patient was not seen by anyr one until half. past one, when his wife went in and foundt him sleeping so soundly and heavily that no amount of

shaking or shouting could rouse him in the least. She leftt- him in a small dressing-room on the bed in a comatose con-e dition, and summoned medical aid. As she had to procure a

cab and send some four miles, it was ten minutes to foure o’clock before aid arrived. The patient was found cold,o pulseless, and not perceptibly breathing. He was lifted at

d once into a large adjoining room, and placed across the bedh with his head towards the windows, which were at once

856

opened to their fullest extent. The chest was bared, andthe Silvester method for restoring animation vigorouslyand perseveringly resorted to. The first effect was violent

diarrhcea, next faint sobbing, fitful respiration, then stiffen-ing of the limbs to a slight extent, succeeded by copiousvomiting, then stertorous breathing, giving way gradually toslight twitchings of the limbs, muttering, anxious question-ing, and at ten minutes to six o’clock complete consciousness.The efforts for restoration were never relaxed, except thatthe Marshall Hall method was now and then substitutedfor the Silvester. The face was pale throughout, therewas no perspiration, the pupils were contracted, and theeyes were not suffused. ____

PAYMENT AND DUTIES OF MEDICAL OFFICERSOF HEALTH.

THE salaries of medical officers of health are so insigni-ficant in many places that it is quite apparent they arenot intended to perform any duties, but are appointedsolely in obedience to the commands of the Local Govern-ment Board. At Redruth, a large mining town in Cornwall,for instance, the medical officer of health is now paid &pound;5 5s.

per annum, whereas his salary was fixed at first at &pound;25.The members of the local Board of Health consider thatthe duties are performed as well now as formerly, and this,we suppose, must be interpreted to mean, as no report ofhis work is furnished, that little or nothing is done, or, intheir opinion, required to be done, by such an officer.Those who know mining districts in general, and Redruthin particular, and have studied the mortality returns, willnot coincide in such an optimist view. Either the neces-

sary work should be done, and the medical officer fairlypaid for his time and trouble, or the money of the rate-payers should not be expended on a nominal appointment,without any duties attached thereto. Dr. Hudson, as amember of the local board, made an energetic protestagainst the continuance of such a proceeding, and we hopethat his views will be duly considered, not only by the in-habitants of Redruth, but of numerous other places wheresimilar arrangements prevail. A combination of districtsis the only safeguard against local prejudices and inefficientsanitation, and all hygienic reformers should urge its

adoption. ____

SANITARY INSPECTION OF TENEMENTPRO,PERTY.

AT a recent inquest held with reference to a death inFrances-street, Lambeth, evidence was given which pointsto the necessity for more systematic inspection of all houseproperty, in urban districts, let out in tenements. The

inquest was held upon the death of a woman aged seventy-six years, which, according to medical evidence, was causedby inflammation of the lungs and heart disease; the womanwas very much emaciated, and Mr. Monday distinctlyasserted that her death had been accelerated throughsleeping in a room "which was not fit for a dog to lie in:’It was stated that the deceased had been in receipt of2s. 6d a week, but that owing to her dirty habits theguardians had stopped her allowance with a view to herremoval into the workhouse. The coroner (Mr. W. Carter)expressed a hope that the condition of the houses in Frances-street would receive the attention of the local sanitaryauthority, a hope which will probably now be realised. Itis still more important, however, that measures should beadopted to avoid the scandal and danger to the communityinseparable from such a catastrophe as the death of thispoor old woman, partly from living in a room 11 not fit for adog to lie in." Sanitary authorities of poverty-strickenneighbourhoods are too apt to disclaim responsibility for

the results of the degrading filthiness of the lowest class oftenemented houses ; it is clear, however, that responsibilitymust rest somewhere. Primarily it rests with the ownersof such property, who should not be allowed to escape theobligations of ownership; and, secondly, with the localsanitary authorities, whose clear duty it is to enforce all

needful measures of precaution, and thus to render impos.sible such a tragedy as that which recently occurred inFrances-street, Lambeth.

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UNIVERSITY COLLECE MUSEUM.

DURING the last few months some important additionshave been made to the anatomical museum of UniversityCollege. The curator, Dr. E wart, has prepared and mountedin plaster-of-Paris a series of dissections similar to thoseused at the examinations of the College of Surgeons, and itis intended to increase the number of these dissections. Toassist the students in the use of these preparations, Mr. R.Quain has bad them drawn, and the drawings, which arewell executed in colours, with all the objects named, arehung up close to the dissections. A set of bones, with theattachments of the muscles clearly marked on them,mounted in bottles, has also been recently added. As themuscular attachments have been marked by the curators,and not, as is so often the case, by the preparer of thebones, they are accurate, and will prove useful to thestudents. Braune’s life-size coloured plates have beenframed and hung up for reference. A new cabinet, con-taining Liston’s collection of surgical instruments, has justbeen erected. Some may remember seeing these at the1851 Exhibition ; they are of great interest, and will repaya visit. It seems a pity that they should not have beenplaced in the museum before. We are glad to find that acatalogue of the museum is in course of preparation, and,indeed, will soon be ready. We hear that Mr. R. Quainbears the expense of its printing. A good catalogue cannotfail to add very greatly to the value of the specimens.

SYRUP OF CHLORAL (LIEBREICH).

OuR attention has been called to the syrup, chloral. (Lie-breich) introduced by Messrs. Corbyn. It is prepared inGermany by Prof. Liebreich, and bears a label containingthe extraordinary statement that " It is the only preparationon which the profession can rely for the production of thetherapeutical effects of the remedy." Whatever credence

may be given to the statement that the evil effects ofchloral are invariably due to its impurity, a statement whichcertainly has not been proved to be true, the assumptionthat pure chloral cannot be prepared by English manu-facturing chemists appears to us a most extraordinaryone, and certainly reflects in a very unpleasant manneron the ability or the honesty of English chemists. Aserious objection to the above-named preparation is thatit is only one-third the strength of the syrup. chloral.

(B.P.) If it should come into use there will almost cer-

tainly be some fatal mistake in dose made by thosewho, after taking the German, take some of the Englishpreparation, and then, probably, the accident will beascribed to the impurity of the latter !

FEEDINC PER RECTUM.

AN article appears in the Deutsche Zeitschriftfilr PraktischeMedicin (No. 44, 1877), in which Dr. Kauffmann drawsattention to the excellent results he has obtained from theplan of feeding the patients with pancreas and meat incases of persistent and incurable intestinal obstruction. Hestates that he has had nine patients in the K&ouml;lner Burger

857

Hospital, seven of whom were suffering from cancer of thecesophagus, one from cancer of the pylorus, and one fromchronic ulcer of the stomach. In all of these a cleansingenema was administered in the morning, followed by theintroduction into the rectum of a mixture of a pound of

finely divided beef, and one-third of a pound of finelyminced pancreas, the whole being freed from fat and con-nective tissue. Half of this quantity was used at noon, andhalf at 6 P.M. The results were excellent; a solid well-

formed, healthy evacuation was discharged every day. Thepatients were able to walk about, and lived for nine or moremonths.

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SANTONIN AND STRYCHNIA.

ABOUT two years ago we thought it our duty to cautionour readers regarding the possible evil consequences of

comparatively small doses of the favourite anthelminticsantonin, and affirmed that the administration of a very fewgrains sometimes produced convulsions of the gravestnature in children. We did not at the time hazard an

opinion as to whether the poisonous effects observed weredue to a change which the powder had undergone (e.g., it

readily oxidises in a strong light), or to the admixture of amore potent drug; but recent events show that the latterview is probably the correct one. We find reported in theCanadian Pharmaceutical Journal brief particulars of twocases of poisoning from santonin, which on analysis wasfound to contain a large proportion of strychnine. One caseterminated fatally, and in the other death was only avertedby the most prompt and energetic measures. An action atlaw is pending with regard to the latter case, at the con-clusion of which we shall no doubt obtain some interestinginformation. Meanwhile we would call the attention of thewholesale drug houses to this matter, and suggest thedesirability of examining stouks of santonin.

THE SMALL-POX OUTBREAK AT FARINCDON.

WE asked last week with reference to this outbreak in

Faringdon, How came it that the disease was permitted tospread as it did from the first case ? What action did the

sanitary and vaccination authorities take in the matter ? aHas Faringdon any means for isolation ? We have beenfavoured with a partial reply to these questions. Our in-formation relates to certain admonitory notices issued, or

proposed to be issued (we are not certain which) by thesanitary authority, but of public means of isolation and ofdisinfection, and of the action of the vaccination authority,not a word is said. Surely this is a case for inquiry for theLocal Government Board, and we would ask those resident,who, in view of the apparent inefficient action of the sanitaryauthority during the outbreak, are agitating for a LocalBoard, to memorialise the Local Government Board for amedical investigation of the circumstances attending theoutbreak.

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LACTIC ACID AS AN HYPNOTIC.

LACTIC ACID, originally discovered by Scheele in fer-mented milk, is one of the products of the metamorphosisof tissue in muscle, and was suggested by Preyer as anhypnotic on theoretical grounds. Dr. Mendel has latelycarried the theory into practice, giving from one to twodrachms for a dose in the form of lemonade sweetened with

sugar, and diluted, or in double those doses as an enema,neutralised with the same quantity of carbonate of soda,since in its pure state it acts as an irritant to the intestine.It is said to act best when the conditions preventing sleepare of a mental nature, whilst it is inoperative if the

sleeplessness is occasioned by pain.

A REAL case of burying alive has taken place in Naples.Some time ago a woman was interred with the usual cere-

’ monies, and soon afterwards, the grave in which she hadbeen deposited having been opened for the reception of

’ another body, there were presented appearances which, proved beyond doubt that the woman was not dead when

buried. She had torn her clothes to pieces, and even frac-. tured her limbs, in her efforts to release herself after re-

covering consciousness. The Appeal Court of Naples has, just sentenced the doctor who signed the certificate of death,

and the Mayor who sanctioned the interment, respectivelyt o three months’ imprisonment for 11 involuntary man-slaughter."

THE number of deaths registered in London last week, amounted to 1579, showing a mortality-rate of 233, one

slightly higher than that of the previous week. Ofthe deaths from the seven principal zymotic diseases, 31were due to small-pox, 81 to measles, 52 to scarlet fever, 5

’

to diphtheria, 27 to whooping-cough, 36 to different formsof fever, and 16 to diarrhoea. The fatality of diseases of therespiratory organs still shows a tendency to rise, the deaths

’

due to them last week numbering 417, against 313 and 409,

in the two previous weeks respectively.’ A BARQUE has arrived at Plymouth with two of the crew’

suffering from scurvy. The disease, however, has not pre-sented itself in its most virulent form. The Board of Trade

’

medical officer, has, it is reported, instituted an inquiry intothe cause of the outbreak, and finds that there was an

’

ample supply of lime juice, preserved meats, &o., on board,and that there was nothing in the diet of the men whichcould have produced the disease. The outbreak conse-

quently assumes a somewhat mysterious character.

THE sanitary condition of Chobham would appear to bevery unsatisfactory, to judge by a recently issued report ofthe medical officer of health for the district. During athorough inspection of the village by this gentleman he didnot find a single well of water that was not, in his opinion,contaminated. Certain recommendations have been made

’

by the medical officer which should be adopted by the ruralsanitary authority without delay.

DURING the Centennial Exhibition in Philadelphi::. it. appears that a very large amount of illness existed in the, city, some particulars of which have been recently given’ by the Philadelphia Medical Gazette. At the Centennial

Hospital no less than 6463 cases of injury and disease weretreated ; and among the Japanese exhibitors, who acutelyfelt the change of climate, 18 per cent. suffered from entericfever.

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IT may not be uninteresting to medical superintendentsand others to give the cost of maintenance at some of theestablishments under the control of the MetropolitanAsylums Board during the past half-year. At Leavesden

Asylum it was Is. 1d. per head daily; at Caterham Is. 2’-Id.;at Clapton Asylum 1s. 11d.; and at the Exmouth training-ship Is. 10&frac14;d. per head daily.

WE are gratified to be able to contradict a groundlessrumour to the effect that Sir Wm. Muir had resigned. Itis pleasant to know he has not any such intention. Sir

Wm. Muir discharges his official duties at the Army MedicalDepartment as usual. ____

THE Fulham Hospital, which was opened for the receptionof small-pox patients on the 10th of March last, is now

closed. Of the 629 patients admitted, 303 were convalescentstransferred from other establishments.

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THE Board of Delegates for the management of the Hos- pital Sunday Fund have brought their labours for this yearto a close. At their final meeting last week it was statedthat the Fund had received X275 more than last year, while&pound;350 less had been spent, and that the awards were madethree months earlier than after the collection in 1876.

AN inquiry has recently been instituted in Cork by theLocal Government Board in reference to the prevalence offever ; and from the evidence given up to the present, itappears that the increased number of cases of enteric feveris due principally to defective drainage and bad sanitaryarrangements. ____

IT has been reported to the Uxbridge Rural SanitaryAuthority that 208 cases of scarlet fever had lately occurredin the parish of Norwood, exclusive of 40 cases at theSt. Marylebone Schools.

SANITARY SCIENCE IN GERMANY.

I.

WITHOUT placing ourselves in the position of those whoare guilty of throwing stones whilst living in glass houses,we cannot but feel with some satisfaction that in most

sanitary arrangements of a public nature we stand a longway in advance of our continental neighbours. With few

exceptions our streets are cleaner and better lighted; ourhouses better warmed, and drained, and ventilated; our

supply of water larger and of better quality than any thatmay be seen abroad. Here and there no doubt greatabsurdities might be pointed out in our system-nonegreater, perhaps, than that law which can be put in forceto compel the formation of a main drain, and can compelalso each house to have its own system of drainage, butwhich is powerless to compel either the owner of the houseor the corporation of the town to join the domiciliary drainwith the main one. Still, on the whole, in large towns andcities, something has been done to render them habitable,to extend the duration of life, and to prevent the develop-ment of disease. Our example has not been without fruit,and with more intelligent views in regard to the nature ofdisease, the advantages of sanitary science are everywherebeginning to make themselves felt. We have lately re-ceived the first handbook published in Germany on PublicHealth,l and as its contents are particularly interesting weshall take the liberty of abstracting some of its more im-

portant parts, from which, as is usual in any subject treatedwith Teutonic patience and care, it will be found we mayourselves receive instruction.We may remark at the outset that the author has not, as

is too frequently the case with German writers, limited him-self to a consideration of the progress made in his depart-ment by his own countrymen, but has evidently paid theclosest attention to the hygienic improvements that havebeen made in this country and to our literature, and hasproduced a work which will add to his reputation, and whichwe should be glad to see translated, as our own literature,except in the form of Blue-books, is in this respect ratherscanty.In attempting to give our readers a brief abstract of some

of the more important subjects discussed, we feel that wehardly do justice to the author, as it is difficult to removeany part from the context without spoiling the whole.In the first chapter Dr. Sander treats-1. Of what should

1 Handbuch der &ouml;ffentlichen Gesundheitspflege. Von Auftrage desDeutschen Vereins fiir offentiiche Gesundheitspflege. Verfasst von Dr.Friedrich Sander, Oberarzt des stadtischen Krankenhauses in Barmen.pp. 500. Leipzig : Hirzel. 1877.

be the aim and object of the department of public healthin a State. 2. Of our knowledge of avoidable disease.3. The history of public hygiene.He commences with some remarks on the proper nomen-

clature of his subject, and at the outset discards the term11 hygiene," apparently because it was originally employedadjectively in Greek, did not pass into the Latin tongue,and was only first used by Galen; all of which reasons, we

think, are feeble, and curiously illustrative of the tendencyof the German mind to retain their long, uncouth, thoughexpressive phraseology, in preference to accepting a newforeign word. After referring to the great increase in thepopulation of certain countries, he states that R&uuml;melin hascalculated that at the present rate of inarease, and notwith-standing emigration, Prussia, in the course of 300 years, willhave 650,000,000 population; and even this is far exceeded byourselves, a calculation which he gives having shown thatif avoidable causes of death were removed, especially ininfancy, in eighty-seven years all England would be aspopulous a,s London is now. At this rate Lord Dufferin’sdiscovery that Canada contains some open ground, andStanley’s that the centre of Africa is habitable, do notcome an hour too soon, and a company had better be formedat once for promoting settlement in those regions.He then proceeds to treat in general terms of avoidable

disease. Using our mortality tables, he shows that theaverage mortality deduced from the returns of 623 regis-tration districts in England is 22’4 per 1000 per annum,whilst in 54 of these districts it did not exceed 15-17 per1000. If all men lived to 80 years of age, the yearly mor-tality would be 12-7 per 1000. The difference between 12-7and 17 per 1000 Prof. Sander puts down to preventable dis-ease. He discusses at length the value of the figures ob.tained in such tables, and in the course of his remarks givesnumerous references to statistics obtained from Germantowns and districts.On the question of Putrefaction and Fermentation the

author gives a very good r&eacute;sum&eacute; of the opinions now held,showing how some, including so cautious an observer asDe Bary, consider that bacteria are the cause of decom-position, essentially on the ground that the nature of thedecomposition can be directed by the nature of the sporessown in certain fluids ; whilst other observers of equaleminence, as Helmholtz and Hoppe-Seyler, maintain thatbacteria only, in general, accompany, but do not induce, theprocess of putrefaction, since some fermentations and meta-morphoses occur without their presence. Dr. Sander appliesthese conflicting views in an interesting manner to theorigination of disease, and quotes the observations of

Panum, Hiller, and others, showing that the germs-usingthe term in a very broad sense, so as to include proteinousparticles even-are extremely resistent to high temperaturein some instances and to chemical agents in others. The

general result is, as Hallier expresses it, that in ferments ofa putrefactive power we have not to deal with any singlesubstance, but with a number, varying even with the stageof decomposition. Septicsemia and diphtheria he considersthe only diseases directly proved to be due to putrefactiveimpregnation of the system, though he quite admits thatscarlet fever and the zymotic affections of Dr. Farr’sclassification are each induced by a specific cause. Hemakes a second group of cholera, and a third of malarialdiseases. The question of the mode of production of cho-lera is very fully discussed, in regard to which the authorappears to be in accordance with Pettenkofer, whose viewswe some years ago took occasion to lay before our readers,and which are sufficiently known. An important section isdevoted to the consideration of the production of phthisisby various unhealthy employments, and of the effects on