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ruptured bladder we cannot begin again, for if our selectedmeans should fail, death will place the patient beyond thereach of surgical art.—Yours obediently,

WALTER RIVINGTON, M.S.Lond.Finsbury-sqnare, July 13th, 1SS3.

--

WALTER RIVINGTON, M.S. Lond.

"ABDOMINAL HERNIA AND ITS CON-SEQUENCES."

RUSHTON PARKER, B.S., F.R.C.S.,Professor of Surgery in University College, Liverpool.

To the Editor of THE LANCET.SiR,-With the notice that you were good enough to take,

on July 21st, 1883, of my pamphlet on Hernia, I have notmuch fault to find, as it seems to me to be neither disin-

genuous nor unappreciative. Where your writer has clearlyunderstood me he has, in the main, concurred with me ;and I have no objection to the slightly disparaging tone ofhis last paragraph, which justifiably points out what I admitto be a verbal inaccuracy of style. I am glad to perceive,however, that even this fault of mine has not concealed mymeaning from the reviewer. I omit allusion here to thesubject of so-called "omental strangulation," on which hisviews are expressed in merely hypothetical terms. Buttheie are two points on which he entirely misrepresents, ifhe do not actually misunderstand, me. I take the secondfirst. Referring to the subject of intestinal perforation and itsrelation to the presence or absence of collapse, his languageis here, though probably right grammatically, not logicallyquite so clear as it might be. But as I understand him, hecharges me with ignoring the collapse resulting fromperitoneal infiltration of fseoes ’ The whole of this sectionwas written by me for the express purpose of noticing whathe erroneously charges me with omitting, The ideaobviously conveyed by me is that there is no such thing as"the collapse of perforation per she"; but that when per-foration permits the large escape of faeces into the peritoneum,the collapse which undoubtedly follows is the I I collapse ofsepticaemia," due, of course, to the absorption of the putridmaterials. One cannot be expected to be at laborious painsto remind one’s readers that rapid septicaemia is one of theacknowledged but various and different promoting causesof the general condition termed "collapse." " For due con- I

sideration of "collapse" from every point of view, however,reference may be made to an address by Professor vonNussbaum, published in 1877,1 abstracted in English onMav 15th of the same year in the London j11edical Reco1’d.The other, and last point of which I wish to notice,

is the utter misrepresentation by the reviewer of the term"intestinal obstruction" as I understand and employ it.In this he merely follows the too prevalent practice of

attempting the hopeless task of separating the cases causedby functional laming from those caused by a more plainlymechanical occlusion. The essential symptoms are alike inall, I care not what the variety, though the degrees of acute-ness truly differ ; but that does not help the diagnosis, oralter the immediate obligations as to treatment.

Cases illustrating my view are continually being published,and I need not multiply them, but I may add that Ihave known a case of intussusception, discovered by post-mortem, in which there never was complete constipationfrom first to last, and in which we felt certain during lifethat, whatever the form of intestinal obstruction, we mightsafely exclude intussusception. I have also known a casein which the symptoms were sudden and most acute ; greatpain, temperature of 103’, quickened pulse, belly distendedand uncertainty as to the existence of a circumscribedtumour, everything noticed at the first visit consistent withthe presence of intussusception, yet to which hopeful medicaltreatment was promptly and continuously applied, withimmediate benefit, but undergoing daily remission, followedby daily ameliorations, under the assiduous enforcement ofthe most rigid abstemion from milk and all solids, andunder the repeated injection of morphia subcutaneously.Even here, it took the patient a month to recover entirely,under the most exactly appropriate treatment; thoughwithin the first two days it appeared extremely probablethat the obstruction was of some "functional" kind, perhapspermitting the impaction of food in the first instance. Suchcases are those which, when teased with the finger, withenemata, or with milk and other improper ingesta, ofteneventually die, and reveal post mortem what some are pleased

1 Aertzliches Intelligenzblatt, March 13th.

. to call " no signs of obstruction." Why, the whole thing is"obstruction" throughout, from the last stool preceding theseizure to the first puff of wind per anum after improvement.By "intestinal obstruction I I do not mean solely one of

the mere anatomical causes of obstruction, be it strangu.lationof a hernia (internal or external), invagination, volvulus,band, constriction of any kind, pressure, &c., but I mean the

great and portentous facts involved in the physiologicalaberration by which the intestinal propulsive functions areobstructed ; and that not merely by the inconvenience,however great, of a mere passing and passive constipation,but the active indication that such " obstruction has com-menced. I care not for the immediate purposes of treat-ment in the urgent interests of the patient, whether it bedue to any of the perfectly definite causes just enumerated,or to the equally potent influence of peritonitis, enteritis,or other functional conditions that leave no trace behind forpost-mortem satisfaction or reproach ; it is enough that" symptoms of obstruction

" are present. Everybody knows

what these are, and the first thing to do is to proscribe food,and (generally) to prescribe opium. Even in strangulatedhernia, which is not always immediately recognised or reco-gnisable, the same treatment is required to prevent aggra-vation of the symptoms should the necessary operation beinevitably postponed or waited for.So surely as cases are not promptly treated tenderly in this

way, so surely will some of them continue to develop from acomparatively harmless " bellyache

" to a formidable or fataldisease. It is impossible, in a communication that should beconfined within limits that I must have exceeded, to do morethan touch upon the points immediately concerned, but Idesire to correct obvious misinterpretations.

I am, Sir, your truly,RUSHTON PARKER, B.S,, F.R.C.S.,

July, 1883. Professor of Surgery in University College, Liverpool

* * We regret that Mr. Parker has omitted to give in hispamphlet evidence that the collapse of perforation is merelycollapse of septicaemia; he appears to us to have overlookedthe other explanations of that state. The concluding para-graphs of Mr. Parker’s letter appear to us to justify in everyparticular the remarks to which he takes exception.—ED. L.

ON THE CHINESE ORIGIN OF SYPHILIS.

D. J. MACGOWAN, M.D.

To the Editor of THE LANCET.SiR,-An annotation in THE LANCET of March 31st, 1883,

on the "Antiquity of Syphilis," moves me to select from myunfinished essay on "Syphilis in China," a contribution tothe history of this much-debated question.

Chinese writers on syphilis state that that malady wasunknown in their country, meaning thereby the Valley ofthe Yangtze and regions northward, until about the middleof the ninth century of our era, when it came from Cantonand spread gradually over the empire. It extended to Japanalso, as stated in the work by Dr. Schulze in Virchow’sArchiv. Of hardly less interest is the fact that the Chinesewere the first to employ mercury in the treatment of syphilis,its use being synchronous with the advent of the new con-tagion. If I might quit the realm of fact for the region ofconjecture, I should say that Arab traders conveyed thepoison, as well also as its mercurial antidote, from Cantonto the West, and that its appearance in Southern Europe,late in the fifteenth century, was due to that agency. Itappears to be much less virulent now than when firstdescribed. I am, Sir, yours faithfully,June, 1883. D. J. MACGOWAN, M.D.

LIVERPOOL.(From our own Co2,re,", o)bcle2tt.)

THE EYE AND EAR INFIRMARY.

MR. EDGAR BROWNE has had a very interesting series ofcases of detachment of the retina, treated by paracentesisand by subcutaneous injections of pilocarpine. The imme-diate results have been sometimes brilliant, but Mr. Brownepoints out that in the great proportion of cases a relapse willoccur. Very satisfactory results have been obtained incataract cases with a preliminary iridectomy performed six

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weeks before extracting the lens. Mr. Browne’s lectures onrefraction and the use of the ophthalmoscope will be resumedin October. They were largely attended last winter bysenior students and junior practitioners. An hour’s lecturewas followed by a demonstration on patients of the subjecttreated. An importation of erysipelas from outside thehospital, that at one time threatened to prove disastrous,was successfully dealt with by promptly removing all thepatients into the upper wards, and by ceasing all operationsfor a fortnight. A considerable proportion of cases of"tobacco amblyopia" occur among sailors, who smoke avery strong tobacco called twist.

THE BRITISH MEDICAL ASSOCIATION ANNUAL MEETING.

The arrangements for this meeting, which commenceshere on Tuesday the 31st inst., have for some time past beenin a very forward state, and little remains now to completethem. A very large and most successful gathering is con-fidently expected. Although so large a city, Liverpool is,se to speak, very centralised. Most of the principal hotelsare in close proximity to the chief, aud within easy distanceof all the, railway termini, and of the river. The chiefpublic buildings, where the soiree and annual banquetare to take place, and the Liverpool College, where all themeetings are to be held, are all within a very short walk.The tramway system has been so extended as to facilitatelocomotion very greatly, and for the purposes of such ameeting there could hardly be a more convenient place thanthis city. From the programme, as already published, thesubjects for discussion are of a very practical nature, and themeeting promises to be important in its professional aspectsas well as successful as a social gathering.THE CITY COUNCIL AND THE ISOLATION OF FEVER CASES.

It was stated at the last meeting of the City Council thatnegotiations are being made between the Health Committeeand the managers of the Netherfield Hospital for InfectiousDiseases for the transfer of the latter to the Corporation.Such an arrangement would be very desirable. The hospitalis conveniently situated in an elevated position, and there issufficient adjoining land for further extension of the hospitalif required.VENEREAL DISEASES AND VOLUNTARY LOCK HOSPITALS.

The probable results of the recent action of the Govern-ment in reference to the compulsory powers of the Con-tagious Diseases Acts may be judged by what is seen in thislarge seaport. At the Lock Hospital there were on the 24thinst. thirteen beds in the female wards occupied and twelveempty. The male wards, on the other hand, are generallywell filled, and there have been lately some very severe casesof tertiary syphilis, also several cases of sloughing ulcers.Within a radius of half a mile from the hospital there aremany streets almost every house in which is a brothel. That aproportion of the inmates, sufficient to fill the empty beds inthe hospital several times over, are more or less diseasedmust be obvious, and yet they are at liberty to spread thesediseases far and wide. The consequence is that syphiliticdiseases prevail to a very large extent in Liverpool.

SCOTTISH NOTES.(From our own Correspondent.)

AN INTERESTING DECISION TO LOCAL AUTHORITIES.

A DECISION of some interest has been given in the courtof session in an action at the instance of certain proprietorsin the parish of Mid Calder against the local authority of theparish. Pursuers asked for a degree of declarator that thedefendants were not entitled either as parochial board or aslocal authority to incur expense in connexion with the

cleansing of the streets of the village, or in connexion withcleansing operations elsewhere in the parish, and that theywere not entitled to levy assessment over property ,in theparish for such a purpose. Defendants stated that thoughthis village of 651 inhabitants could not adopt the GeneralPolice Act, conditions arose so inimical to health that theironly resource was the employment of scavengers ; and theymaintained in law that the payments for cleansing havingbeen lawfully made by them in the exercise of their powersat common law, they should be assoilzied. His lordship was

of opinion that in such parishes as this, when the parochialboard was constituted the local authotity in term, of tuePublic Health Act, 1867, and when a coasidcrabte viliaewas placed under their authoiity, it was not beyond thupower of such local authority, acting under the Board ufSupervision, to direct inspectors to see to the cleansingof the streets, and, if necessary, to employ scavengersfor the purpose. The plea of the defenders was thussustained. One would imagine it rather late in the dayfor a case of this kind to occupy the superior courts ; butin view of doubts which must have existed on the subject,and the urgent calls now being made upon local authoritiesto’ be in readiness against the approach of cholera, it is wellthat the timid amongst the authorities should be madeaware that disbursements will be repaid from the rates.

MURRAY ROYAL ASYLUM, PERTH.The report of this institution for the past year shows con-

tinued progress in adapting the asylum to the most modernwants ; and apparently Dr. Mitchell’s report may bethoroughly relied on when he says, " all the changes intro-duced by Dr. Urquhart tend to make the house healthier,to increase the chances of cure in the curable, and to add tothe happiness of the lives of those who are beyond hope ofcure." There were 24 cases admitted during the year; therewere 16 discharged ; the total number under treatment was105, the average number 79 ; and there now remain 84. Dr.Urquhart reports that the institution now receives casesearlier, and as a result of ten admittances within threemonths of the onset of the malady, eight are now recoveredor convalescent. One patient said on admission, " that hesought to be treated here for the same reasons that wouldhave prompted him to call a surgeon had he broken hisleg "; and we are not surprised to notice that that patient’speriod of detention was short. None of those who re-covered during the year had been resident over six months.Perhaps the only disagreeable occurrence in this asylumduring the year was an outbreak of typhoid fever, throughwhich one patient died. The cause could not be foundwithin the building, and I suppose Dr. Urquhart did notcare to say distinctly that the water-supply of the town is atfault. He mentions that typhoid has not visited the asylumfor at least nineteen years, and we know it is not long sincehe first reported the use of Perth water. During the pastyear many important structural changes have been made,and the system of drainage, water, and gas-pipes is nowvery complete. Both Dr. Sibbald and Dr. Mitchell seem mostfavourable to the whole arrangement of this institution.

THE "SCOTTISH NATURALIST."It appears that a new issue of this journal has been re-

solved upon, and the first number has appeared. For severali years conducted by Dr. Buchanan White for the Perthshire, Society of Natural Science, and later for the Messrs. Black-. wood, it is now some time since the spirited venture had to. succumb. It was always prized by the students of sciencei and societies throughout the world, and it may be hoped: that under the editorship of Professor Trail of Aberdeen a

prolonged lease of life may be obtained.ABERDEEN INFIRMARY.

Contrary to what was at first expected, there seems tobe a rush of medical candidates for the vacancy in thesuperintendentship of this infirmary. The decision of thedirectors on the question of a lay or medical governor doesnot seem yet to be given, but the method which for so manyyears wrought so well under Dr. Rattray will not be given

t. up without earnest consideration.

IRELAND.

(From our own Correspondent.) )

ROYAL UNIVERSITY OF IRELAND.

AT a recent meeting of the Senate, the term of officeof Lord O’Hagan as Vice-Chancellor having expired,he was unanimously re-elected. The Senate have orderedthat after next year all candidates for the diplomain obstetrics shall be required to undergo a special writtenexamination in midwifery, gynaecology, and diseases ofchildren. A meeting of Convocation was held last

week, the first business being the election of a senator.