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MEDICAL ANNOTATIONS.

four pounds of soft soap; the preparation will then be com-pleted, and the quantity sufficient to dip fifty hogs." Now," says Mr. BLACK, the farmer, "the ’dip’ was too

" strong; the arsenical poison was absorbed by the skins of the" animals, and thus caused their death. I must be paid £1700."Professors DICK and GEORGE WILSOX, Dr. MURRAY THOMSON,and Mr. WILLIAM BIRD gave evidence in support of Mr. BLACK’Smode of accounting for his loss. Mr. ELLIOT’S (the druggist)defence is as follows:-" The ’dip’ was not too strong, being" only one-half the strength of some of the best and most suc-"’ cessful sheep-dipping mixtures employed in Great Britain." The arsenical poison was not absorbed by the skin ; such ab-

"sorptive action cannot, at least does not, ensue by the sound" skin of the sheep from immersion in ordinary arsenical baths." The sheep were not killed in the way stated, and I am," therefore, not liable to the heavy damages you lay againstme." " Pray," retorts Mr. BLACK, " how were my sheep de-" stroyed then? Were they not killed by arsenic, and did not

" your wash contain that substance ?" " Thus were they de-

" stroyed," replies Mr. ELLIOT : "you did not dip your sheepwith proper care, and as you were bound to do; your sheep" were too hastily dipped; the wool was afterwards imperfectly"pressed, thereby leaving much liquid in the fleece; the"animals were then sent to a grass field ; the poisonous" wash dripped, or was washed from the sheep by rain," upon the grass ; the sheep ate the grass, and thus were the

"animals poisoned. I am not responsible for such want

"of ordinary caution upon your part. Moreover," repliesMr. ELLIOT, " the symptoms preceding the death of your sheep" were those of arsenical poison, introduced by small, re-

" peated doses into the system, and not those of poisoning by" a single dose of that deleterious agent. The falling off of the" wool in patches is sufficient to prove this."The question for the jury to consider was, which of these

two theories of the death of the sheep was the more propableone, and whether the druggist’s "dip" was reasonably fit to beused according to the printed directions supplied with it.

The jury found a verdict against the druggist for X1400 infavour of the farmer.

We have carefully read over the papers of Dr. MACADAMand Mr. JOHN GAMGEE, as also the report of the trial. Havingdone so, we cannot endorse the opinion of the latter gentleman,that the destruction of the sheep was caused by carelessness onthe part of the farmer and his men. It was proved in evidenceby Mr. BLACK, that he applied to Mr. ELLIOT, the druggist,in consequence of an advertisement by the latter, which ap-peared in the Berwick, Advertiser. That advertisement is not

before us. Obviously much would depend upon its mode ofconstruction. But it does not seem that Mr. BLACK appliedfor an arsenical wash; and, certainly, nothing in the printeddirections furnished by Mr. ELLIOT showed that in his fifteen

packages there were contained 300 ounces of one of the mostdeadly of metallic poisons. Considering the quantity of arsenic

supplied, the instructions given by the druggist were, in ouropinion, most discreditably unequal to the occasion; and nowonder that the animals were poisoned by the drippings of sofatal a solution on the grass they were set to eat.Much praise is clue to Dr. MACADAM for his careful and

elaborate chemical investigation into the action &c. of " sheep-dipping mixtures." He has shown us that myriads of sheephave been bathed with impurity and that sheen-dinning mix-

tures are not absorbed by the skin. In the particular case be-fore us, he has stated the fatality to be due to the sprinkling ofthe grass by the poisonous solution, and the introduction of thearsenic into the alimentary canal; and he has traced the exist-ence of that poison in the contents of the stomach and intes-tines of the sheep. It is but fair that we should specially directattention to the discussion which took place at the Pharmaceu-tical Society of Edinburgh on the occasion of Dr. MACADAM andMr. GAMGEE reading their communications on the 4th of Marchlast. Dr. MURRAY THOMSON defended the opinions he hacl

advanced in support of the claims and views of the farmer.If the verdict obtained by Mr. BLACK covered the loss he

sustained by the death of his sheep, we believe it to be a

righteous one, and hope it will not be disturbed.

OUR readers cannot fail to have observed the distressinginquiry that is now pending respecting the alleged death, bypoison, of a lady of the name of BANKES, at Richmond, Surrey.The party accused of the horrible offence has been representedin the reports of the public joarnals to be " Dr. THOMAS SME-THURST," and also as "Mr. THOMAS SMETHURST, Surgeon."Now, on examining the Medical Directories for England, Ire-land, and Scotland, we do not find any person of that nameas a member of any department of the profession in this king-dom. In fact, the name of " SMETHURST" is not to be found in

any one of the Directories we have mentioned.

Medical Annotations."Ne quid nimis."

PROGRESS OF DIPHTHERIA.

THE progress of diphtheria in this country should be watchedwith careful minuteness by epidemiologists and by practicalphysicians. The extreme alarm occasioned by its first out-break appears to have subsided with the sudien increase of

mortality to which it gave rise, but the disease has not the lessadvanced throughout the country by sure and steady steps, andstill haunts the towns and villages, weariz?g its severest andmost fatal type. For many weeks it has averaged nineteen totwenty victims in the metropolis, while its ravages in the

country have been varied and extensive throughout the lastquarter. The Registrars’ notes appended to their returns tothe Registrar-General constantly reproduce this as the cause ofan enhanced mortality. In the south-eastern counties, we findit gave rise to no less than 18 out of 45 deaths from all causesat Tunbridge, and that it has prevailed at Tenterden, Ashford,and Dover, causing an eighth of the whole number of deaths inthe latter town. Passing from Kent to Sussex, we find 7 deathsout of the entire mortality of 16, at Frant, reported as due todiphtheria occurring to children under six years of age; whileat Uckfield, East Grinstead, Brighton, and Horsham, it was

busy in the work of death. The south-midland counties havebeen nearly free. But not so those of the eastern division of

England. Essex still continues to suffer. At Rochford, thedeaths have greatly exceeded the average in consequence ofthe prevalence and fatality of diphtheria amongst infants;while this disease has been " very prevalent" in Maldon andSaffron Walden. It has found a resting-place in Suffolk, andstill hangs about Norfolk, prevvilin g at Tunstead, at Cromer,(where it adds 11 deaths to the 33 contributed by all other dis-eases,) and at Aylsham, where it stands to all other diseases as11 to 59. At Loddon it carried off 3 members of one family.In the south-west it still prevails, but is on the decline. Taun-

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ton and Chew Magna, in Somersetshire, have suffered smartly. The west-midland counties have much to complain of from theseverity of the disease-not one county excepted; and Stafford-shire has added a century of victims. The north-midlanddivision is, however, that which has suffered most severely.Lincolnshire felt its influence in an universal increase of thedeath-rate. Moulton found the deaths doubled by it; itadded there 10 deaths to 17 from all other causes. Lincoln

lost 17; Horncastle, 17; Saltfleet, 18-total mortality, 47;Great Grimsby, 19; Caistor, 15-total mortality, 53; and

hardly any other district escaped the loss of a large proportionof its inhabitants-carried off by this fatal malady. ThroughDerbyshire and Nottinghamshire it passed also with destroyinghand. The north-western counties felt more sensibly its de-structive force than in preceding periods. It harboured therein Chorlton, Manchester, Haslingden, and Blackstone, in Lan-cashire. In Yorkshire it is recorded at Dewsbury, EcclesallBierlow, Sheffield (causing 46 deaths), Crowle (15 deaths outof 40 from all causes), Goole, Howden (10 deaths out of 5Sfrom all causes), Langtoft, Rillington, Malton (causing 12

deaths out of a total of 66), and Northallerton. In thenorthern counties it was less prevalent, although we find

60 deaths recorded in some districts of Durham, and othersat Morland, in Westmoreland. It still lingers in Wales,amongst the romantic scenery of Chepstow and Pontypool; atCardiff, Merthyr Tydvil, Lower Montgomery, and Corwen. Inthis last locality it caused one-fourth of the whole mortality.Without analyzing more minutely these records, it may be

observed that they fully bear out the conclusions deduced bythe previous inquiry instituted by THE LANCET. Diphtheriais still seen, sometimes coincident with croupal affections,sometimes following in the wake of scarlatina: unquestionablya type of disease wholly distinct from scarlatina, since it

constantly infests districts where scarlatina does not exist;and, again, is found a dangerous enemy during convalescencefrom scarlatina; chiefly fatal to children less than six years ofage; clearly aggravated by those incidents of miasma andputridity which feed all zymotic disease, but still existing,independently of them, in well-drained and otherwise healthydistricts; prevailing, with more than common energy, in themarshes of Essex and Lincolnshire; and visiting those miserablehuts on every moor and lowland that are destitute of all neces-

sary sanitary arrangements. It is clear that diphtheria is aneminently zymotic disease, against which all the arms of sani-tary and medical prophylaxis may be advantageously used.

PORTRAITS OF MEDICAL WORTHIES.THE medical profession are of necessity interested that,

amongst the celebrities whose portraits adorn the walls of theNational Portrait Gallery, now in process of formation, thoseillustrious medici should find a place whose names are glorious inthe roll of our profession, and whose services have contributed tobanish disease, to allay suffering, and to prolong life. We seewith pleasure that portraits of some of the most distinguishedof our recent worthies have already been acquired. There isan excellent and characteristic portrait of the immortal Jenner,which forms a pendant to that of Harvey. The inventorof vaccination, and the discoverer of the circulation of the

blood, look down from the walls in illustrious comity. The

portrait of Jenner was presented by J. C. Moore, Esq., inFebruary. It is a half-length, by Northcote, painted with nogreat refinement or care. Jenner sits at a table, his work onvaccination lying open before him, and a letter, just signed,lying unfolded beside it. A good likeness of that excellentand philosophic surgeon and anatomist, Sir Charles Bell, waspresented in March by Lady Bell. The artist’s name is JamesTannock. It is conventional and somewhat feeble, but isknown to be a fair likeness of Sir Charles Bell when a youngman. The most remarkable of the additions to the portraitsof medical worthies is that of John Hunter, just added.

This is a copy, by John Jackson, R.A., of the famous portraitby Sir Joshua Reynolds, at the College of Surgeons. That

portrait, one of lleynolds’s most celebrated works, and charac-teristic alike of the painter and the anatomist, is now in a stateof irrecoverable decay, and is hastening fast to a total extinc-tion of colour. The copy was made when the picture was ingood condition, and is now the most satisfactory record ofReynolds’s masterpiece ; Sharpe’s fine line engraving conveyingan impression of but a moiety of its merits. Jackson was atonce an accomplished portrait-painter and a great admirer ofReynolds, and he executed his task with all the zeal and suc-cess of a labour of love. In the better days of the Reynoldsportrait of Hunter, this bore comparison with the originalsingularly well; and now that that canvas is so darkened anddefaced by time as to be almost undecipherable, even by theaid of a friendly imagination, the copy of which the nation hasbecome possessed has acquired a special value. It was thisconsideration which influenced the trustees in departing, inthis particular case, from a rule which they have hithertoadopted, and the operation of which excludes copies, of what-ever merit, from the national collection.

MEDICINE FOR THE MILLION.

WE have to announce to the medical world a series of disco-veries which will be received with sentiments of disagreeablesurprise. It has been discovered by four members of theprofession, that the sums paid for medical attendance are

" heavy and indefinite;" that " first-rate advice is only to beobtained at considerable cost, and is adapted but to the meansof the few;" and that this, together with "the high priceusually charged for medicine" is really a very serious matter.Those who know the labour which the medical practitioner un -dergoes in scraping together an average income, how vast arehis responsibilities, how great his sacrifices, how wide his cha-rities, will feel that this is no other than a calumny couched inthe form of philanthropic proposition. It is impossible that anythinking person, who looks round upon the busy, laborious, andill-paid activity of the medical world, who is conversant with theworking of the great hospitals and the minor infirmaries, thesystem of Poor-law relief, and the ordinary routine of medicalpractice, should arrive at so monstrous a conclusion, by a pro-cess of unbiassed thought. But these gentlemen are not un-biassed. This proem is employed to introduce and recommend,in the advertising sheet of an Islington local paper, a Medicaland Surgical Institution, established " in order to meet suchcontingencies, and to afford the best medical and surgical aid tothe many at the least possible cost."

" The fee for the advice and assistance of the medical officers,together with the necessary medicines, will be 2s. for eachpatient. The great advantages arising, as well from the mo-derate extent as from the precise limitation of this paymentsmust be at once evident, and stand in striking contrast to theheavy and indefinite expenses usually involved in a course ofmedical treatment. As the demand on each individual purseis so small, nothing short of very large numbers can at all com-pensate for the necessary outlay, and when it is considered thatphysicians and surgeons of acknowledged eminence and effi-ciency must be liberally remunerated, and that the medicinessupplied are of the utmost purity and freshness, it will be evi-dent that the great expenses of the institution require to bemet by corresponding amount of public support. The pro-moters of this institution therefore rely on the early and effi-cient support of the public. In order to extend the range ofits benefits to the working portion of the community, it hasbeen determined to issue one shilling tickets, to be obtained atthe institution, conferring the same advantages as are derivedby those paying the regular fee; and it is suggested that itwould be a great kindness to present such tickets to domesticservants, and many others, to whom small sums are an object;so that the institution may be the means of promoting thegreatest good to the greatest number.’ A physician and sur-geon in daily attendance."The names of the gentlemen who thus propose to supply

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cheap medicine for the million are-Klein Grant, M.D.; G. C.Holland, M.D.; Mr. J. Frampton Smythe; and Mr. R. S.

Hayman. In Dr. Klein Grant we regret to recognise thebiographer of Dr. Hope, and editor of " Hooper’s Dictionary."The other names are unknown to us. We are sorry to iindthem in connexion with an enterprise of which we are com-pelled to express an unqualified disapprobation. The project,and the style of oration by which it is introduced to publicnotice, are only worthy of a " cheap Jack" puffing off hiswares to country bumpkins.

ROYAL COLLEGE OF PHYSICIANS OFEDINBURGH.

R. CHRISTISON.

Reasons of Dissent against the Pesolution of the College of the20th of April, refusing to restrict the Licence to UniversityGracL2eates.

1. BECAUSE the evident tendency, if not the purpose, of theresolution, is to lower the constitution of the College, bycreating in it a new order of general practitioners, who, notbeing medical graduates, nor surgeons, nor physicians in thesense hitherto understood in Scotland, will have neither a dis-tinguishing name nor a legal standing in this division of theUnited Kingdom.

2. Because the creation of such new order of general prac-titioners is not called for by the public interests, nor by anyknown circumstance in the condition of medicine or of societyin Scotland.

3. Because such creation is not called for by the interests ofthe College.

4. Because, on the contrary, the measure is dangerous tothe welfare of the College, as being of a kind to engenderestrangement on the part of the graduates of universities, towhom alone the College has been hitherto indebted for itsprosperity and its reputation.

5. Because the creation of the new class of practitioners,which will be the result of the resolution in question, mustgive umbrage to other medical corporations in the UnitedKingdom, and more especially just cause of offence to theRoyal College of Physicians of London, with whom this Col-lege has hitherto acted harmoniously in organizing its consti-tution.

R. CHRISTISON.

We, the undersigned Fellows, adhere to the above reasons of,dissent:-

THOS. STEWART TRAILL. J. HUGHES BENNETT.WILLIAM ROBERTSON. ROBT. PATERSON.J. BROWN. A. PEDDIE.ALEX. JACKSON. ROBT. BowES MALCOLM.JOHN YOUNG MYRTLE. WILLIAM CUMMING.J. BEGBIE.

Edinburgh, April 26th, 1859.

Correspondence."Audialteram partem."

STATISTICS OF AMPUTATIONS.

JAMES ARNOTT, M.D.

’1’0 the Editor of THE LANCET.

SIR,- " Audi alteram partem" is a standing admonition inyour journal; and I avail myself of the invitation implied init, with reference to a criticism, in your journal of the 30thult., of my proposition,-that the ulterior effects of chloro-form, administered in severe operations, are injurious.The proposition is founded on all the reliable published sta-

tistics of operations performed before and after the introductionof chloroform, which, from the similarity of circumstances,could fairly be made subjects of comparison. The work re-

viewed in THE LANCET of the above date expresses a differentopinion, founded partly on the same data, and partly on othersunknown to me because unpublished, or rejected by me becauseinapplicable from dissimilarity. As this opinion appears to beadopted by the reviewer, and as it may be presumed that thosewho awarded a prize to its propounder approve of it, I think itproper to notice it.The data furnished by the London hospitals, and which have

been used in common by this writer and myself, are accessibleto everyone. According to my calculation, they show a mor-tality, after the severer amputations, of 34 per cent. since theintroduction of chloroform ; according to the writer of the workreviewed, of only 28 per cent. As I took much pains in makingthis calculation, and am therefore very certain of its correct-ness, I can only attribute the great difference between the twoestimates to the latter including the minor amputations, as ofthe fingers and toes. With respect to other statistics broughtforward by this writer, I shall only observe, that if tables of

mortality occurring under very different circumstances are

compared together, and if the data occurring in some shortselected period are few, the most erroneous inferences will bedrawn. This writer asserts that certain manuscript reports inthe possession of the Medico-Chirurgical Society snow that themortality from amputation of the limbs before the use of chlo-roform amounted to 33 per cent.: Air. Philipps relates that,about twenty years ago, the Council of the same Society ob-jecte 1 to the publication of his paper on the Statistics of Am-putation, because they considered his estimate of a mortalityof 23 per cent. as being much too high.As chloroform, though greatly restricted in its use in several

of the provincial hospitals, still continues to be constantly em-ployed in the hospitals of London, it is natural that every kindof evidence that can justify this extensive use should be eagerlyreceived. But surely, if this evidence be of the statisticalkind, the universally admitted rules of such evidence should bestrictly complied with, particularly those respecting the authen.ticity of data, the sufficiency of their number, and their simi.larity. If these circumstances are disregarded, the most perni-cious errors may be the consequence.

I am, Sir, your most obedient servant,London, April, 1859. JAMES ARNOTT, M.D.

"INSTRUCTIONS TO VACCINATORS."To the Editor of THE LANCET.

SIR,-The "Instructions for Vaccinators," lately issued byorder of the Privy Council, are calculated to be useful in re-minding medical practitioners of various precautions connectedwith vaccination which are apt to be neglected.

I may be permitted to doubt, however, whether they expressin every instance the unanimous opinion of those best acquaintedwith the important subject of which they treat. There is oneof the rules in particular upon which I am anxious to make afew remarks.Under the second head the vaccinator is instructed to "vac-

cinate directly from the vesicle of a previous subject whereverthere are proper means of doing so." And no one will questionthe propriety of this advice. But it is added, "moist lymphconveyed from case to case in a vial or in other like mannermust not be used for vaccinating later than eighteen hours (orin very hot weather twelve hours) after it has been taken fromits source." I have not the slightest objection to this summarydisposal of the stoppered vial, which I never used, and have nogood opinion of; but the words "in other like manner" are,doubtless, intended to apply to the capillary tubes, and to in-clude them in the same condemnation. Whether this prohibi-tion is generally acquiesced in by medical men in England I donot know; but it has excited not a little surprise here, wherethe tube method is in common use, and highly valued for itssimplicity and efficiency. The "Instructions" are not, indeed,addressed to us, there being no Vaccination Bill for Scotland;but high as is the authority under which they enanate, theyare not above criticism from whatever quarter it may come,and one is even doing a service to his medical brethren and tothe cause of vaccination when he states reasonable objectionsto any portion of them.My objection to the second rule, then, is that it condemns

and actually prohibits the use of a method which has been provedby am_ple experience to be safe, simple, and efficient en a very highdegree. Of course it will be admitted that to restrict the timeof keeping the fluid lymph to twelve or eighteen hours is equi-valent to condemning the use of the tubes altogether, just as asimilar restriction in the case of the ivory points would beequivalent to suppressing the use of them. I do not know pre-cisely by what argument this sweeping prohibition is justified,or whether the public vaccinators of England acquiesce in it asso reasonable, so manifestly right, as to need neither argumentnor evidence to support it; but, on the other hand, I can referto the experience we have had of the method for the last tenyears in Edinburgh, where it is, as I said, in common use, andis admitted on all hands to facilitate greatly the practice of