653MR. SIMON ON FILTH DISEASES AND THEIR PREVENTION.

notion that common observation and common intelligencewould alone suffice to cope with it. Filth as commonlyunderstood, stink as commonly understood, and cleanlinessas commonly understood-these were long the three car-dinal principles of sanitary administration. How miserablythey failed at all times to effect their purpose is part of thesanitary history of the country, to which Mr. Saxon nowcontributes the latest paragraph. The real work of sani-

tary science and its teaching during the past thirty yearshas been the gradual unlearning of the sufficiency of com-mon apprehensions of filth and of cleanliness for thoroughand efficient sanitary work, and of the necessity for basingsuch work upon medical knowledge of the modes in whichfilth produces and in which cleanliness removes unwhole-someness.

What constitutes an intelligent appreciation of the

ways in which filth becomes destructive, as also " a

clear intelligence of what cleanliness really means," it

is the purport of this Report to show. Both subjectsare treated with suggestiveness, and both will demand in-

dependent examination. For the present we limit our

observations to certain considerations which arise out of

the paragraph last quoted. The principle here referred toas requisite to proper protection from the mischievousnessof filth, and which in a previous sentence is spoken of asindispensable to sanitary administration in modern times,"underlies the argument which has always been used for theemployment of a medical officer of health as a necessarypart of local sanitary administration; and the suggestededucational influence of that officer as a teacher of the

modes in which filth, or other injurious agencies, becomehurtful, has at all times been regarded as one of his mostimportant functions. Consistently with these views, afterthe passing of the Public Health Act of 1872, which madethe appointment of a medical officer of health compulsoryupon all sanitary authorities, the regulations of the LocalGovernment Board provided that first of all he should

"inform himself as far as practicable respecting all influ-ences affecting or threatening to affect injuriously the

public health -within his district"; that 11 he should inquireinto and ascertain by such means as are at his disposal thecauses, origin, and distribution of diseases within the dis-trict, and ascertain to what extent the same may have de-

pended on conditions capable of removal or mitigation";that " he should keep himself informed of the conditions

injurious to health existing therein"; and be "prepared toadvise the sanitary authority on all matters affecting thehealth of the district." This was the interpretation, in thefirst instance, by the Local Government Board of the pri-mary functions of the medical officer of health as intended

by the Legislature-an interpretation based upon long-accumulating experience of sanitary administration andadministrative requirements. But at the time when these

regulations were issued, we now know from the reports ofthe general inspectors of the Board recently published, thatthe Local Government Board had determined to ignore itsown regulations and to revert to the general conceptions ofsanitary administration which existed thirty years ago-an administration based (to use a happy expression of

one of the inspectors) "upon our common senses and our

common sense." The inspectors were instructed, it wouldnow appear, to consider common conceptions of filth,of stink, and of cleanliness, as represented by the in-

spector of nuisances, as the groundwork of sanitary adminis-tration, the medical officer of health being reserved forthose special occasions where the inspector of nuisancesconfesses himself at fault, or where an irruption of diseasedemands strict medical knowledge. In other words, the

inspectors were to intervene between the existing know-ledge of sanitary science and requirements of sanitary ad-ministration and the new sanitary organisations, s-absti-

tuting for the guidance of the latter such conceptions asthey might have of sanitary matters, matured (as Mr.STANBFELD has told us) by a two days’ gossip with theirfellow Poor-law inspectors and their President. Such is an

example of the signification given by the Local GovernmentBoard to "common sense" in its application to sanitaryorganisation and administration.

Annotations.

THE COLLEGES OF PHYSICIANS ANDSURGEONS.

" Ne quid nimis."

ALTHOUGH we have already published an abstract of therecent address of the President of the Royal College ofPhysicians, and made comments thereon, it is, we think,desirable to refer to it again, if, indeed, the occurrences oflast week do not render it absolutely imperative. The chiefinterest of the address is centred in the passages relatingto the action taken by the various licensing bodies co-operating for the formation of a Conjoint ExaminationBoard. The history of the scheme is passed in review fromits initiation up to the time when its progress was tempo-rarily arrested by the Council of the College of Surgeonsfinding that the provisions of their charter would not allowthem to carry into operation the proposals to which theyhad agreed with the College of Physicians. Mention is,however, made of the attempts by the Council of theCollege of Surgeons to obtain an Enabling Act of Parlia-ment to 11 give them the power to carry out, if they maythink fit," as Sir George Burrows puts it, 11 the scheme whichthey originated and prepared in conjunction with the uni-versities and ourselves." This remark on the action ofthe College of Surgeons is significant, and throws consi-derable light on some subsequent events. It will be remem-bered that, six weeks ago, in commenting on the ConjointExamination Scheme, we referred to a letter from the Pre-sident of the College of Physicians that had been read at ameeting of the Council of the College of Surgeons. This letterrelated to the famous resolutions of January 14th, which,among other things, proposed that the College of Surgeonsshould have the power to elect ten out of forty examinerson the Conjoint Board, including therein not less thanthree-fourths of the examiners in surgery. We remarkedthat this letter was severe in tone, and expressed unqualifieddisapproval of the resolutions, which, we said, had beencharacterised 99 as a reversal of the proceedings of the co-operating authorities for the last three years," and, con-sidering the importance of the question and the mover ofthe resolutions-Sir James Paget,-we did not hesitate toexpress our regret that the proposals were not deemedworthy of more than very summary judgment by the Pre-sident of the College of Physicians. Our present duty is

654

not to make any comment on the resolutions, but to

speak only of the letter. According to the statementof Sir George Burrows, which we reported last week, itwould appear that the letter referred to was not a public buta private one, and that the version which we had publishedwas imperfect. More than this. Indirectly it has beeninsinuated that we could not have known anything what-ever concerning the letter except through some "breach ofconfidence on the part of a member of the Council. These

.

statements cannot, in justice to ourselves and others, belightly passed by. We may say at once that had we knownthat the letter written by Sir George Burrows to thePresident of the College of Surgeons was regarded by himin the light of a private, not an official, communication, weshould not have thought it necessary to refer to it in anyway, even if under such circumstances it had been readat a meeting of the Council of the College of Surgeons.It was sufficient for the purposes of comment that the letterwas founded on an interview between the presidents of thetwo Colleges, in the presence of their respective secretaries ;that it was expressly written to serve as a record of thatinterview; that it was read at a full meeting of the Councilof the College of Surgeons; and that it was ordered to beplaced on the Minutes. We did not, consequently, for onemoment doubt that the letter was written by Sir GeorgeBurrows in his official capacity as President of the Royal Col-lege of Physicians. But the question as concerns ourselvesis now a simple one. We could not possibly be expected tohave understood Sir George Burrows’s intentions in writingit. His communication we regarded as an official one, forthe reasons we have stated. It is clear, however, that, if itis to be considered a private letter, it should be at once erasedfrom the Minutes of the Council of the College of Surgeons-indeed, it should have never found a place there; if not, SirGeorge Burrows can have no objection to express to theprofession generally an opinion which he readily gave toone of its members, who happens for the time to be Pre-sident of the College of Surgeons. The adoption of thiscourse would certainly lead to a definite result, and woulddoubtless rectify all misunderstanding.And now as to the vexed question of privilege. The pro-

ceedings of the Council are, in the abstract, supposed nodoubt to be strictly private; but everyone knows that prac-tically the medical press has, as a rule, little difficulty inascertaining what has been done. It is now out of timeand out of place, and quite opposed to the spirit of the age,to charge us with a breach of privilege, because we claim(as members of the profession and as fellows and membersof the College) the rigilt to know and comment freely,but fairly, on anything that has been done at a meet-

ing of the Council of the College of Surgeons. More-

over, the more intelligent and enlightened members ofthe Council are desirous of publishing accurate reportsof the meetings, and even of admitting reporters. But,altogether apart from the general question, we main-

tain that in the present instance we have a perfect rightto know what has been done and what is being done bythe various bodies to whom the profession, the Govern-ment, and the nation have entrusted the management ofthe Conjoint Examination Scheme. Seeing that this is amatter that has already been brought before the membersof the House of Commons, and by that means before thenotice of the country, and upon which Parliament maysooner or latter be called upon to offer an opinion, if not tcgive judgment, it seems almost ridiculous to expect thalmembers of the profession, and the people generally, shoulcbe afraid to speak for fear of breach of privilege, while thfrepresentatives of two licensing bodies were disputing abouithe vested interests of their rival colleges.

THE BIRMINGHAM MEDICAL INSTITUTE.

IF there were at any time doubts as to the real state of

feeling in the medical profession in the Midland districtrespecting the admission of professed homoeopaths into theBirmingham Medical Institute, they should be effectuallyremoved by perusal of a letter sent to Mr. Oliver Pembertonby Dr. Arlidge, Chairman of the North Staffordshire Sub-Branch of the British Medical Association, the representa-tive body of the profession in the district. The followingis a copy of the letter :-

April 23rd, 1875.DEAR SiR,-At a meeting of the North Staffordshire

Sub-Branch of the British Medical Association, held on the18th inst. at Stoke-on-Trent, the efforts made by yourselfin opposition to the admission of homoeopaths to the Bir-mingham Medical Institute were discussed, and a resolutionwas proposed and carried expressing the Society’s approvalof the course adopted by you, and its regret that the opposi-tion was unsuccessful.

(Signed) J. T. ARLIDGE, M.D.,Chairman of the North Staffordshire Sub-Branch of

the British Medical Association.Oliver Pemberton, Esq., Birmingham.

We venture to affirm that if the question had originallybeen properly submitted to the consideration of the mem-bers of the profession in Birmingham and the neigh-bourhood, an overwhelming majority would have decidedagainst the admission of homoeopaths. As it is, largenumbers of the medical men of the district have declined tobecome members of the institute if homoeopaths are ad-mitted. This course has unfortunately the serious drawbackthat it puts those members of the institute in favour of theadmission of professed homoeopaths in the majority.

THE SENSE OF TASTE

THE precise physiology of the sense of taste is a subjectto which a good deal of attention has been devoted, butthere still remain some obscure points to be solved in con-nexion with it. It is well known that a great number ofthe sensations commonly included under the name of tasteare in reality appreciated by the olfactory nerve. This isthe case with nearly if not quite all of the aromatic andodorous flavours, as is clearly seen in cases of anosmia;whilst sour, salt, and astringent tastes are due to impres-sions on the nerves of common sensation, and are probablythe results of chemical action. But the appreciation of11 sweet" and 11 bitter " tastes is a special function, locatedin certain limited areas of the tongue, which are pro-vided with special forms of papillse, and to a small portionof the palate and fauces. Of these, the anterior portion ofthe tongue, close to the tip, and the posterior third of thedorsum.are the most important, both possessing the powerof discriminating sweet and bitter; but the anterior portionbeing apparently more sensitive to sweet, the posterior tobitter, tastes. The latter area is supplied by the glosso-pharyngeal nerve, which appears to act as the taste nerve;but with regard to the former, which is supplied by thelingual branch of the fifth, some doubt exists. Dr. A.

Davidson, of Liverpool, has recently drawn attention to thesubject in a paper 11 On the Sense of Taste, and its Relationto Facial Paralysis and Anaesthesia," in which he discussesthe various views which have been advanced, and relatesthree cases bearing upon the question. The results of £clinical observation and of physiological experiment appearto show conclusively that the sense of taste in the anteriorarea is dependent on the integrity of the chorda tympani,since injury to the fifth nerve, above the junction of thelatter with it, although accompanied by complete anses-thesia of the side of the face and tongue, does not necessarilyaffect the sense of taste; whilst, on the other hand, when

655

the chorda tympani is injured or cut taste is lost withoutloss of sensation. According to some, who regard thechorda tympani as a purely motor nerve, this is due to theaffection of the functions of the submaxillary gland, or tothe loss of power of erection of the taste papillee. Neitherof these explanations, however, appears to be satisfactory,and the weight of evidence would seem to be in favour ofthe view that some of the fibres of the nerve are afferent.In one of Dr. Davidson’s cases there was complete paralysisof the portio dura on the left side, of deep origin, accom-panied by entire loss of taste in the corresponding half ofthe tongue in the anterior part. In another case there was

right facial paralysis from disease of the internal ear, andloss of taste on the right side of the tongue. In the third

case, there was complete anaesthesia of the parts suppliedby the fifth nerve on the right side, probably resulting froma fracture of the skull; but although there was completeloss of sensation on that side of the tongue, the sense oftaste was for some time unaffected. Its subsequent im-pairment is ascribed by Dr. Davidson to the changes in themucous membrane of the tongue consequent upon impairedinnervation. This case may serve to explain some anomalouecases in which injury to the fifth was associated with im.pairment of taste. Dr. Davidson believes that the tast(nerves pass by the chorda tympani to the facial, and thencEprobably by the nerve of Wrisberg to the brain.

THE ARMY MEDICAL SERVICE.

THERE is no sign of abatement in the expressions of dis-satisfaction at the present state of things in the ArmyMedical Service, or in the interest manifested as to thecharacter and scope of the proposed remedies. We continueto receive numerous communications on the subject. The

opinions as to what should be done are, however, diverse;and the number of pamphlets, which Mr. Gathorne Hardyspoke of having received, have probably proved a source ofmore embarrassment than assistance to him. He ought bythis time, however, to have become acquainted with everyphase of the question. As far as we can understand, allmedical officers are in accord in abusing a system whichis neither one thing nor another. As was recently pointedout in our contemporary the Globe, medical officers are now,to all intents and purposes, staff or departmental, and notregimental officers, notwithstanding that they may be tem-porarily attached to a regiment for duty. Under such cir.cumstances it was not to be expected that they would becontent to pay the same contributions and subscriptions tcregimental messes as if they were bona fide officers of thE

corps to which they were attached. A correspondent in outcontemporary pointed out that medical officers are not de.sirous of accepting anything from regiments without pay.ing the full value for it, but he contends that they enjono other privileges than would be extended to honorarJmembers of a mess; and the medical officers feel that theare placed in a false and unfair position by this rulinof the Horse Guards. They are taxed every bit as muclas any regimental officer of equivalent rank who full:participates in the advantages and hospitality of the messwhich they allege they do not. The proper and preferabl,course would surely have been, under the altered conditionin which medical officers are now placed, to have madthese " attached" officers either honorary members paying a higher rate for messing, or the ordinary subscriptionin addition to the actual cost of messing, without the contribution of fifty days’ pay on joining. We are glad tperceive that Mr. Gibson was to ask the Secretary of Statfor War whether it is the fact that officers of the Arm

Medical Service, when first attached to a regiment, a’

though not permitted to wear its uniform or to describ

themselves as belonging to it, are compelled to pay fiftydays’ pay as a contribution to its mess and band funds,and whether it is his intention to remedy such an unfairstate of things, if they exist. It is also much to be re-

gretted, we think, that the allowances to which medicalofficers are entitled are not stated in a plain and unmistak-able way; for it seems to be a common source of complaintwith them that their so-called relative rank affords them no

guarantee or protection in this respect. Now that theyhave all become acquainted with the terms of the Naval

, Medical Warrant they naturally expect that Mr. Hardyi will adopt a similar course in regard to their service.L His declarations and reference to that Warrant have donel much to stimulate their hopes, and they are anxiouslyl awaiting the War Minister’s decision in regard to them.

SIR THOMAS WATSON ON VIVISECTION.

THE current number of the Contemporary Review containsa short article by Sir Thomas Watson, written in that

temperate and judicial tone which might have been ex-pected from his pen. Sir Thomas Watson does not discussthe whole question, but contents himself with endeavouringto calm the disquietude that has arisen, by showing thatvivisection may be both lawfully and mercifully practisedwithin certain limits and under certain conditions. To

justify such experiments, however, there must be somedefinite object in view that shall hold out some reasonablehope and prospect of resulting benefit. Sir Thomas con-siders that no one is justified in making any painful expe-riment upon a living creature who does not possess the

skill, judgment, intelligence, and previous knowledge requi-site to render the experiment successful and instructive;

,

that experiments are not to be repeated, however mercifully.

conducted, nor is an animal to be even deprived of life, forthe purpose of illustrating that which is already established,’

or merely to appease the natural curiosity of students; andthat it is only in order to settle once for all a disputedpoint of importance that a single repetition of experimentsmight reasonably be allowed. The remainder of the paperin question is taken up with a popular elucidation and ex-i planation of certain nervous phenomena in animals by the

t light of well-known physiological laws.

THE HAMPSTEAD HOSPITAL.

A M’EBTiNO of the Committee of the whole of the Metro-

politan Asylums Board was held on the 30th ult., to reporton the site for an infectious diseases hospital at Mill Hill,offered to the Board by Mr. J. Harvey, in place of the sitenow occupied by the Board at Hampstead. The Committee,by a majority of 35 to 5, agreed to a report of which the

following are the chief conclusions :-The distance of theproposed site from the great mass of the population forwhich the hospital was to be provided was objectionable.The objections urged against the Hampstead site wouldequally be urged by persons holding property adjacent tothe Mill Hill site, and in view of these objections, although" probably equally void of solid foundation, when dispas-sionately considered, the Committee failed to see what

justification the managers could give for removing from the! one site to the other." Further, Dr. Frankland had ex-

pressed an opinion that the contiguity of an infectious dis-: eases hospital to a water company’s reservoir, as would be the. case at Mill Hill, might give rise to much alarm among the. consumers. The Committee therefore recommend the Board

"to decline Mr. Harvey’s offer, and, with the object of

putting an end to further agitation, they also recommend- the Board henceforth to decline the consideration of anyfresh sites, should such at any time be offered to them

656

that, with a view of quieting the fears of some of the in.habitants of Hampstead, the Committee advise that it bEfully explained it is at present intended that the HampsteacHospital shall only be used for the reception of infectiouscases in the event of such an epidemic arising as wouldrender the hospitals of the managers at Homerton anc

Stockwell unequal to provide for the patients sent thereto;and that if, in the meantime, the Hampstead residents willpoint out what extra precautions they think might reason.ably be taken for the protection of the neighbourhood, themanagers will readily give their views a careful considera-tion."The next meeting of the Board, at which the Committee’E

report will be considered, is announced for the 8th inst,Meanwhile the Committee of Hampstead Residents haEobtained a report from Dr. Letheby traversing Dr. Frank-land’s objection to the site at Mill Hill, with respect to anydanger of infecting the Grand Junction Water Company’Ereservoir there.

___

ON THE PHYSIOLOGY OF THEPERSPIRATION.

NEARLY one-half of the last part of the Zeitschrift jiirBiologie (Band xi., Heft i., 1875, pp. 1-78) is occupied withan elaborate paper by Dr. Friedrich Erismann on CutaneousTranspiration. As is usual in German memoirs of this

kind, there is a very complete historical account of the sub-ject, in which the observations of Krause, Seguin, Valentin,Reinhard, Weyrich, Pettenkofer, and many others, are

given. Erismann set himself to determine the amount of

evaporation that took place from the surface of dead skinthe inner surface of which was in contact with water, withobservations on the evaporation from the whole body andfrom particular parts of it; and, secondly, to study thevariations of cutaneous transpiration from the living bodyunder the most varied external and internal conditions, thelatter branch of the subject of course including the effectof clothing. For the description of the apparatus used wemust refer to the original. It appears to have been well

adapted to the purpose intended. M. Erismann satisfied

himself, in the first instance, that with dead skin it was ofno consequence, in regard to the amount of evaporation,whether the internal surface was in contact with water orwith serum. A distinct relation was demonstrated betweenthe amount of evaporation and the temperature of the air.Yet it appeared that at low temperatures the rise of a fewdegrees was of small importance, whilst at higher tempe-ratures they made a considerable difference. The activityof the process of transpiration seemed to be connected withthe number of sweat-glands, since it was much more activein the case of the sole of the foot than in that of skin takenfrom the chest or belly, notwithstanding the much greatertenuity of the epidermis in the latter case. No increasetook place when the pressure on the inner surface was

great; as, for example, when one arm of a subject was fullyinjected whilst the other was in the natural state. Venti.lation or movement of moist air bad no influence on theamount of evaporation. Removal of the epithelium causedscarcely any appreciable difference. Under ordinary tempe-rature and moisture of the air, Erismann found that the

body of a young woman who died in childbed lost 617 gr.in twenty-four hours. In regard to the living body, he foundthat the relative dryness of the surrounding air was themost important factor in modifying the amount of evapo-ration from the surface. Thus, other conditions beingtolerably equal, the evaporation of water from the skin wasabout 45 gr. when the moisture in the air was 77 per cent.of saturation, whilst it was 899 gr. when the amount ofmoisture was only 15 per cent. The amount also increases

with augmented temperature and with a current of air.The effect of clothes seems to be but slight, and, if any-thing, rather favours than restrains evaporation. The con-

sumption of large quantities of hot fluids favours evapo-ration ; and so of course does work. There can be no doubtthat the sweat-glands are the main agents in effecting cuta-neous transpiration, and much more fluid is lost by theliving than by the dead body.

A NEW CYCLOPÆDIA OF THE PRACTICE OFMEDICINE.

WE desire to call the attention of our readers to a verylarge and important work that has been undertaken byMessrs. Sampson Low and Co., and which is no less thanthe translation of the Cyclopaedia of Practical Medicinenow publishing by Prof. Ziemssen. This Cyclopaedia em-braces the entire range of special pathology and therapeutics.Seven volumes have already been issued in the Germanlanguage, and it is expected that it will be completed ineight more. The translations will be partly done in Americaand partly in England, and one volume is to be publishedevery three months, so that the entire work will be com-pleted in the course of three years. The first three volumesof the translation are already out, and include the considera-tion of the Acute and Chronic Infectious Diseases. Vol. I.contains Typhus, by Liebermeister; Cholera, by Lebert;the Plague, by Liebermeister; Yellow Fever, by Dr. Hoenisoh;Dysentery, by Prof. Heubuer; and Diphtheria, by Dr. Oertel.Vol. II. contains Varicella, Measles, and Scarlatina, byDr. Thomas; Variola and Varioloid, by Dr. Curschmann;Erysipelas and Miliary Fever, by Dr. Zuelzer; Malarial

Infection, by Prof. Hertz; Epidemic Cerebro-Spinal Me-ningitis, by Prof. v. Ziemssen. Vol. III. contains Syphilis,by Prof. Baumler; Trichinosis, Echinococcus, and Cysti-cercus, by Prof. Heller; Infections by Animal Poisons,Rabies, Glanders, Worms, Malignant Pustule, Snake.bite,&c., by Prof. Bollinger.The edition before us is uncommonly well got up, the

printing being excellent, and the translations as a rule veryfairly done. The whole work constitutes a very valuablereflex of the state of medicine in Germany at the presenttime, and contains a large amount of information not readilyaccessible to the English reader. We wish it every suc-

cess, and predict that it will meet with as warm a receptionon this side of the Atlantic as it appears to have had inAmerica. Those who are desirous of making further in-quiries as to the scope of the work, or of becoming sub-scribers, may address to Dr. John W. Palmer, 23, Dorset-street, Portman-square, London, W., who will supply pro-spectuses, &c. We shall have occasion to notice the severalvolumes as they appear.

THE TENBY WATER-SUPPLY.

CONSIDERABLE discussion is going on at Tenby in refer-ence to the water-supply. It appears that two years agothe Town Council employed Mr. Burns, an engineer, toreport upon the best means of procuring a good water-supply, and to prepare plans for the construction of newwaterworks. Suitable springs, about two miles frpm thetown, furnishing an adequate supply of excellent water,were determined upon; and Mr. Burns recommended thatthe water obtained from these should be stored in a coveredreservoir. To this proposition the Town Council declinedtheir assent, and called in another engineer, who gave hisopinion that " no object was to be gained in covering-inreservoirs." This is so distinctly contradictory to the

opinion expressed by Dr. Frankland that we should like toask the engineer in question to give the reasons on whichhe bases his statement. In our report on Folkestone we

657

entered fully upon this question. There it was found that Ithe water collected in the open reservoir contracted con-siderable organic impurity; and although the water fromthe springs was of excellent quality, the water distributedto the town was not so pure as it ought to be, or might bemade if the reservoirs were covered in. It is a well-knownfact that hard spring waters, when stored in open reservoirs,rapidly become contaminated with organic impurities ; whilstsoft waters, though containing a considerable amount oforganic matter, do unquestionably improve in purity. Inthe case of Tenby, however, the water, as we gather, ishard and almost entirely free from organic impurities, andis therefore certain to deteriorate if stored in an open reoservoir. The local authorities seem to have been fortunate

enough to have secured a good water-supply; we hope,therefore, that they will not allow it to deteriorate in theirhands. The expense of covering in the reservoir would besmall; and we should be glad to record that the local

authorities had done all in their power, not only to securea good water-supply for the visitors, but to protect it fromall possible chances of contagion.

THE METROPOLITAN HOSPITAL SUNDAY

ALMOST before our impression will appear, a meeting of Iclergymen and laymen, the veritable representatives, not I,of this clique or the other, but of the churches which pro-vide the Hospital Sunday fund, will have met, and expressedtheir opinions on the more difficult matters to be consideredin distributing the fund. We sincerely trust that a dis-position to harmonise and conciliate will prevail. If therehas been any error so far on the part of the Council, orrather of the Distribution Committee, it has been in a dis-position to be too judicial in its functions-to sit in judg-ment on the merits and demerits of different modes of

charity or different kinds of institutions. We do not saythat the time may not come for such action on the part ofthe Distribution Committee; but the time is not yet.What all friends of the Hospital Sunday Fund must see tobe necessary is to establish the fund as an institution, andto conciliate all parties and all localities in the metropolis.When this is done, and when the Distribution Committeehas acquired the experience of years, its criticisms will begreatly respected. Meantime generosity and charity are tobe preferred to criticism. We hope that the meeting to-day(Friday) will use its great influence in support of these views,The Hospital Sunday Fund is a greater matter than an3particular doctrine of distribution.

SUDDEN DEATH AFTER PARACENTESISTHORACIS.

AN instructive case exemplifying a possible danger fromthe operation of paracentesis thoracis has been recorded byDr. Ernest Legendre in a recent number of the Gazette desH6pitaux. The patient was a farmer who, when first seen,presented signs of considerable elusion into the left pleura,following acute pleurisy fifteen days before. After a weekhad been spent in attempting to promote absorption bymeans of blisters, diuretics, &c., paracentesis was performedby means of Dieulafoy’s aspirator, and three litres of pinkturbid fluid withdrawn. The operation lasted half an hour,was accompanied by slight cough, but was followed bymarked relief. Resonance returned over the chest. Ina very short time dyspnaea recurred; there was copiousoutpouring of secretion into the air-passages and cyanosis,death occurring from asphyxia within the space of fiVEminutes. Dr. Legendre thought the fatal issue to be dueto rapid bronchial secretion, and to the inability of th(lung to expand fully from its being compressed or bounc

down by firm false membrane. Another explanation prof-fered was that it was an example of excessive" albu-minous expectoration " to which attention has been recentlydirected. Dr. Legendre adds that for two years I haveperformed twenty paracenteses by means of the aspiratorfor serous or purulent effusions without the least accident,and, fully confident of the operation, I had declared thatimmediate relief and speedy cure would follow its perform-ance. In spite of the reddish tint and turbidity of thefluid, which was present from the first aspiration contraryto my expectation, I did not expect so rapid a death. It isthis unlooked-for event that has determined me to publishthis observation, deeming it to be of use to my young

! confrores, and to prevent them from compromising their, reputation by affirming, as I did in this case, that marked

relief and certain cure would follow. It will be alwaysprudent to make reservations."

THE PROPOSED SOUTH-WESTERN HOSPITALFOR CHILDREN.

THE authorities of the Victoria and Belgrave Hospitalsmay now be congratulated upon the progress they havemade towards the amalgamation of those charities. It hasbeen decided not to erect the proposed hospital on the pre-sent site of the Victoria Hospital; and though this decisionwill probably surprise some, its wisdom is amply demon-strated by the considerations which we noticed in our lastissue. The Duke of Westminster, who has most liberallyand earnestly striven to forward this amalgamation, has,within the last week, offered, for the erection of the South-Western Hospital, a fresh site upon land now occupied bythe Thames Bank Distillery, in the Grosvenor-road, east ofEmagham-street.This makes the third site which the Duke and Lord

Grosvenor have offered to give for the united hospital, and, ought to forbid the possibility of the amalgamation falling

through. The Distillery site is situated about a quarter of, a mile from the Battersea-bridge site, which we advocatedl last week; both are unusually airy, and recommended by.

economical reasons.

J Attention should be directed to the condition of the riverand of certain docks or creeks in the neighbourhood. The

) importance of securing their absolute cleanliness and highf sanitary order, in view of the settle meet of the question ofI. site, must be evident to the joint committee.

DETENTION OF MEDICAL WITNESSES INLAW COURTS.

IT would be but a graceful extension of the privileges ofexemption enjoyed by medical men if the law would stillfurther protect them from unnecessary detention as wit-nesses in courts. Such detention is not only often a grievousinconvenience and loss to them, but it is also a most serious

hardship to patients who may be in circumstances of criticalor extreme illness. This evil has been well exposed in aletter to the Norfolk Chronicle, by Mr. Frederick Manby, ofEast Rudham, and by the editor of the paper. Mr. Manbywas detained from the beginning of the Norwich Assizes tonearly the end, as a witness in a criminal case which cameon on the fifth day, Sunday intervening. For this, and fortwo journeys to Norwich, and, before the committal, twojourneys to Lynn and two days’ attendance there, Mr.Manby received X8 17s. ! Considering the facilities offeredby railways and telegrams, it is certain that this heavydemand on a medical man’s time could be greatly lessened.Either the cases in which medical men are concerned mightbe tried at a given part of the assize, or the medical manmight, after being duly subpcenaed, be telegraphed for.

658

Such arrangements would be more worthy of this date thanone that takes a medical man away from his patients andhis home for seven days, to say nothing of the argument thatit would keep down the county expenses.

ALLIANCE OF PRACTITIONERS WITHDRUGGISTS.

WE cannot too strongly condemn all alliances by whic1practitioners co-operate with druggists. Perfect and re

spectful independence is the attitude which the druggistand the doctor should respectively hold to each other. Bu1

of all such objectionable relations, one of the worst ÌI

illustrated by what was said at an inquest in JBfanche&oacute;<teJthe other day on the body of a child aged six weeks, ancwhich had been treated only by a druggist. The chil&eacute;was taken to the druggist for a " swelling in th(

region of the bladder," for which it got a lotion and medi.cine. "The deceased went on getting worse." One morn.

ing its mother found it in a fit, and went for a doctorWhen she returned the child was dead. This is anotheiinstance of the unsatisfactory way in which some druggist,tamper with serious cases. But there was a still more dis.creditable feature of this case. The druggist, on being ex-amined, gave the following account of his relations with asurgeon:-"He could not recollect the particular case, because there

were very many children brought to him. Witness wouldhave given a lotion of gillard with opium for a swelling suchas described. Witness did give certificates. A surgeonnamed Mr. - filled them up, but did not always seE

the cases which witness certified. They were filled upentirely by Mr. -. Witness gave him the particularsand then he gave the certificate as if he had seen the case,Witness had been assistant to him for seventeen years."No wonder that the jury expressed a strong opinion about

surgeons giving certificates of death without seeing the

patients. Such conduct seems to us to call for attentionfrom the Medical Council.

THE WORCESTER INFIRMARY.

THE case of Dr. Inglis against the Rev. Martin Amphlettseems to us so clearly in favour of Dr. Inglis, and is so ablystated in a leader of the Worcestershire Chronicle, that weneed not much further discuss the matter. It is, of course,desirable that honorary officers should keep their infirmaryengagements but they labour under the disabilities of othermen: it is impossible for them to be in two places at onetime. And even Mr. Amphlett would allow that an honoraryofficer accepts the office on the condition that he is to be I,allowed to do his duties as a private practitioner. Dr. Inglis iis right, too, in declining to have his conduct judged by Ithe House Committee, whose function is altogether different z’

from that of sitting in judgment on such questions. Hewas quite willing to give explanations to the Executive ICommittee. Dr. Inglis only puts the matter rightly when Ihe represents the medical staff of an infirmary as findingthe skill and the subscribers as finding the money for con-ducting an infirmary, and founding on this an argumentfor a mutually respectful treatment.

THE URINALS AT WATERLOO-BRIDGE.

WE would draw attention to the disgraceful condition ofthe two urinals, situated one on each side of the road, at theMiddlesex approach of Waterloo-bridge. They consist oftwo shallow iron vessels, which are perfectly encrusted withold deposits of phosphates and ammoniacal salts. As thereis no water supplied to keep these pans constantly flushed,they rapidly dry, and then the stench from the decomposingurine becomes most abominable, and is readily perceptible

to the passers-by. Moreover, these places are fully exposedto public view, and, independently of the indecency of suchan arrangement, the eye, as well as the nose, is offended byviewing this foul corner, stained and reeking with half-dry,decomposing streams of urine. The authorities ought atonce to screen this place off from the public gaze, and sub-stitute for the iron pans proper glazed porcelain urinals,kept constantly flushed with water.

THE MEDICAL SOCIETY.

THE Annual Oration of the Medical Society was deliveredon Monday last by Dr. George Buchanan, who chose for hissubject 11 Some Points of Importance relative to ModernHospitals." The oration was carefully studied, full ofvaluable facts and practical suggestions, and closed with avery graceful tribute to that large-hearted philanthropistand physician, Dr. Anstie, whose loss we have so recently hadto mourn. Dr. Buchanan’s valuable contribution to theliterature of preventive medicine will be printed, in accord-ance with the’unanimous wish of the meeting. The eveningterminated with a pleasant conversazione, at which objectsof interest were exhibited by fellows and friends of theP!r)f]ft’c’_

VIVISECTION.

SOME eminent naturalists and physiologists, includingMr. Darwin, Professor Huxley, Dr. Sharpey, and others,have been in communication with members of both Housesof Parliament to arrange the terms of a Bill which would

prevent any unnecessary cruelty or abuse in experimentsmade on living animals for the purposes of scientific dis-

covery. It is understood that these negotiations have beensuccessful, and that the Bill is likely to be taken in chargeby Lord Cardwell in the House of Lords, and by Dr. LyonPlavfair in the House of Commons.

PROMOTION IN THE NAVAL MEDICALSERVICE.

THE following are some of the changes and promotionsin the Naval Medical Service :-Three inspectors-generalretired, and three officers of that rank promoted; and twodeputy inspectors-general promoted. We believe, moreover,that there are now several vacancies on the fleet surgeons’list, which will be shortly filled up. This indicates thebeneficial operation of the new Naval Medical Warrant, ofwhich these promotions are the result.

IT may not be generally known that the late Mr. Win-wood Reade, a journalist of some note, and who representedThe Times in the Ashantee expedition, was brought up to themedical profession. He was for some considerable time astudent at St. Mary’s Hospital, but a love of adventure andtravels led him into the interior of West Africa, on emergingfrom which he wrote a very readable book descriptive ofthe country. His subsequent march with our troops toCoomassie seems to have broken him down. He died a weekor so ago at quite an early age. His 11 Martyrdom of Man"is a book of great literary merit, but calculated to shock theorthodox.

____

IT is reported that the Black Sea quarantine station is tobe removed from Cavak to Bourgas, and that a lazarette willshortly be erected at the latter place. However convenientfor commercial purposes the change may be, it is, on sanitarygrounds, by no means recommendable. Bourgas is (or wasup to a recent date) one of the most eminently dirty townsamong the many unclean ports that fringe the northernborders of the Black Sea, and its surroundings are equallyunsavoury and insanitary.

659

A BBMARKABLT high death-rate among the inmates ofthe Newcastle Workhouse during the last quarter of 1874,as set forth in the report of the Visiting Committee, hasexcited some attention in the town, and was last weekmade the subject of discussion by the Newcastle Board ofGuardians. Mr. Hardcastle, the medical officer of the

workhouse, attributed the unusual mortality to the fact ofa large number of aged and diseased persons being sentinto the house apparently in a dying state. That it wastime this matter should be looked into a little may be sur-mised from a statement in the report that during thequarter forty-one persons were sent into the workhouse

hopelessly ill, and of these fifteen died within a few hoursof their admission. The Visiting Committee accordinglyrecommended that in future, whenever practicable, agedand diseased persons should be allowed to remain in theirown homes, and that the medical officers of the variousdistricts and the relieving officers be requested to use everyexertion to avoid sending such cases to the workhouse.

i

THE attention of Parliament has been called to the sys-tematic evasion of the Vaccination Acts by the KeighleyBoard of Guardians. We had reason some time ago to com-

ment on the ignorance and obstinacy of the Board in thismatter. They persistently refused to instruct their officersto enforce the provisions of the Act, and the result of thisremissness is seen in the fact that last quarter thirty-sevendeaths from small-pox were registered in the place. In the

neighbouring village of Skipton there are now over onehundred unvaccinated children, many of whom will doubt-less fall victims to an outbreak of small-pox which now pre-vails. The example set by the guardians must have a de-plorable effect on the poorer classes in the district, whomthey represent so badly. We are glad to learn that legalmeasures are about to be taken by the Local GovernmentBoard which we hope will bring the guardians to their

senses. ____

THERE is much reason to fear that the use of chloral

hydrate is becoming indiscriminate and mischievous.Medical men everywhere would do well to strongly dis-countenance its consumption except under professionaladvice. Even in the most experienced hands it has provedfatal, and it may be remembered that twenty grains oncegiven by a well-known physician-now dead-as a hypnoticproduced a sleep from which there was no awakening. An

inquest was held at Redhill last week on the body of a lady,when the verdict of 11 died from an overdose of chloral" was

given. She appears to have taken the drug regularly for along time, receiving supplies from a local chemist. Mr. F

B. Hallowes, who made a post-mortem examination of thfbody, concluded that she must have died from an overdosealthough there was unmistakable evidence of diseased heartand lungs. _

THE proceeds of the bazaar held in the Free Trade Hall,Manchester, for the benefit of the funds of the Children’sHospital of that town, have, it is stated, reached themagnificent sum of =821,500&mdash;over three-fourths of the totalamount realised by the Hospital Sunday collections inLondon last year ! The expenses incidental to the bazaarwill, it is understood, be almost entirely met by privatesubscription.

-

AN outbreak of scarlet fever is reported from Ribchester,near Longridge. Up to the present date, twenty-sevencases had occurred, several of which proved fatal. The

sanitary authorities of the district have had their attentiondirected to the epidemic, and are now concerting means fo]arresting its progress.

IN London 1532 deaths were registered last week, in-cluding 11 from measles, 35 from scarlet fever, 7 from diph-theria, 96 from whooping-cough, 30 from different forms offever, 15 from diarrhoea, and 375 referred to diseases of therespiratory organs. It is cheering to find that no deathfrom small-pox was recorded in the period. Two fatal casesof enteric fever and one of typhus occurred in the AsylumDistrict Fever Hospital at Homerton. Forty-four deathswere attributed to different forms of violence.

THE question of infanticide is again occupying the atten-tion of the French legislature. A special committee, ap.pointed to inquire into the causes of the excessive mortalityof children in France, have reported that in the whole

country one-fifth of the children born die before reachingtheir second year, and that of 54,000 children born annuallyin Paris, more than one-half do not reach their fourth year.

Ms. WADDY, we are informed, has been prevented, byabsence from town, from putting the important questionconcerning conjoint boards and half-qualifications of whichhe has given notice in the House of Commons.

MR. ERASMUS WILSON has given a sum of 100 guineas tothe British Medical Benevolent Fund for the augmenta-tion of annuities for aged or disabled members of the pro-faacinm.

Inspector - General H. J. Domville, C.B., and DeputyInspector-General James Jenkins, C.B., have both joinedPlymouth Hospital from Jamaica and Bermuda respectively.

THE DISCUSSION AT THE OBSTETRICALSOCIETY ON PUERPERAL FEVER.

Tnis discussion was resumed on Wednesday last (the 5thinst.), Dr. Priestley, the President of the Society, occupying thechair. We give this week an outline of the debate, of which afull report will appear in our next issue. There was by nomeans the same agreement among the speakers as to the non-specificity of puerperal fever that prevailed at the last meeting iindeed, the majority held the opposite view. From the greatand widespread interest of the question, and the fact that allpractitioners, more or less, must have met with examplesof the affection, it is believed that the debate will extend overat least two more meetings. Should it be still in progress at

,

the July meeting, Mr. Wells stated that Dr. Fordyce Barker,’

of New York, would be enabled to be present. Before the&deg;

debate was resumed a long letter was read from Dr. Matthews’

Duncan, in which the writer expanded the views laid down ir’

his previous communication ; pointing out the hardship endured by the recent prosecutions of midwives for man-

slaughter ; and stating that if " homicide by infection" beindeed recognised in law, no medical man was safe from

prosecution. Dr. Duncan also combated the statement that

recently appeared in The Times to the effect that practitioners, who had cases of puerperal fever abstained from midwiferypractice for two or three months ; a course which he has neveradopted as a precautionary measure in the whole of his thirty

. years’ practice. As this letter will be published in full, weneed not dwell further on it here, save to remark that the

, reading of it was met with decided marks of approbation bythe meeting.

, Dr. BARGES, after commenting on the advantage of such a1 question being raised in bringing together opinions from thosea

not engaged in obstetric practice, and expressing his entireapproval of the opinions contained in Dr. Duncan’s letter, said

1 that puerperal fever (which he defined as " fever in a lying-inr woman") may be divided into two great classes :-(1) Hete-

rogenetic, having its source in a zymotic poison, and (2) auto-