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Looking Back.FROM

THE LANCET, SATURDAY, FEB. 4, 1826.

REVIEW.

The Science of Surgery, or the Principles of Pathology madethe basis of Medical and Surgical Practice. By W. W.SLEIGH, Esq., Lecturer on Anatomy, Physiology, and

Surgery. 8vo. pp. 316. London, 1825. Anderson. Vol. I.We are next presented with the case of the late Lord

Byron, which the author has transcribed from the accountgiven by Count Petro Gambia.

I I April 9th, Lord Byron had suffered visibly in his healthduring the last day or two : the events just mentioned, andthe weather, had made him more than usually nervous andirritable ; but he this morning received letters from Zanteand from England, which raised his spirits exceedingly. Hehad not been on horseback for three or four days ; andthough the weather was threatening, he resolved to ride.Three miles from the town we were overtaken by a heavyrain, and we returned to the town walls wet through, and ina violent perspiration. Two hours after his return home, hewas seized with a shuddering : he complained of fever andrheumatic pains. At eight in the evening I entered hisroom ; he was lying on a sofa, restless and melancholy. Hesaid to me, I suffer a great deal of pain ; I do not care fordeath ; but these agonies I cannot bear. The medical men

proposed bleeding, but he refused, observing, Have youno other remedy than bleeding?-There are many more dieof the lancet than the lance.’ Some of the physiciansanswered, that it was not absolutely necessary to bleed asyet, and I fear were too much inclined to flatter his

prejudice against that operation. But there was not thenthe slightest suspicion of any danger, nor was there any atthat moment.

10th. The next day he felt himself perpetually shudder-ing ; but he got up at his usual hour, and transactedbusiness ; but he did not go from home.

12th. The next day he kept his bed with an attack ofrheumatic fever.

13th. He rose from his bed the next day, but did not goout of the house. The fever appeared to be diminished ; butthe pains in his bones and head still continued : he was

melancholy and very irritable. He had not been able tosleep since his attack, and he could take no othernourishment than a little broth, and a spoonful or twoof arrow-root.

14th. The following day he got out of bed at twelve : hewas calmer ; the fever was less, apparently, but he was veryweak, and suffered from the pains in his head. He wished,however, notwithstanding the weather was threatening, togo out on horseback, or at least in a boat; but his physiciansdissuaded him. It was now thought that his malady was gotunder, and that in a few days he would be quite recovered.There was no suspicion of danger.

15th. The fever was still upon him ; but the pains in hishead and bones were gone. He was easier : he even wishedto ride out; but the weather would not permit. Both onthis day and the day before, he had entertained some

suspicions that his complaint was of no ordinary nature,and that his physicians did not understand it ; but he hadnot the least apprehension of danger.

16th. He was better ; his complaint was following theusual course, and there was no fear.

17th. The next day I contrived to get to his room. Hiscountenance at once awakened the most dreadful suspicions :he was very calm ; he talked to me in the kindest manner.This was the first day that the medical men seemed to enter-tain serious apprehensions of the event: he was bled twice ;first in the morning, and at two in the afternoon, and lostabout two pounds of blood. He did not faint, and his eyeswere lively, but he had no sleep ; he perspired on the headand neck : and the disease seemed attacking the head. Hewas dreadfully distressed by want of sleep ; and he now Faidto Dr. Millingen, I know that without sleep, a man must

1 A portion only is transcribed.

die or go mad : I would sooner die a thousand times.’ Herepeated this to his valet Mr. Fletcher.

18th. During the night of the 17th, he had some attacksof delirium, in which he talked of fighting ; but neitherthat night nor the next morning was he aware of his peril.This morning his physicians were alarmed by appearances ofinflammation of the brain, and proposed another bleeding,to which Lord Byron consented, but soon ordered the veinto be closed. Dr. Bruno entreated him, with tears in hiseyes, to be again bled. No, he said : if my hour is come, Ishall die whether I lose my blood or keep it.

Since their last consultation, the majority of the medicalmen had thought that the crisis of the disorder was nowcome, and that the principal danger now was the extremeweakness of the patient ; and that restoratives should beadministered. Dr. Bruno thought otherwise ; but it wasresolved to give a draught of claret and bark and opium,and to apply mustard blisters to the soles of the feet.Byron took the draught readily, but refused the blisters :

accordingly I was sent for to persuade him, and I returnedin all haste with Mr. Parry.

It was about six o’clock in the evening when he said-I want to go to sleep now; and immediately turninground, he fell into that slumber, from which, alas! henever awoke !On my arrival, they informed me that he was asleep,

and that he had suffered the blisters to be applied, notto his feet but elsewhere. The physicians augured well ofthis sleep-perhaps it was but the effect of the medicine,and only hastened his death." 2

MIDWIVES IN THE RURAL DISTRICTS.

THE conference convened by the Rural Midwives’ Associa-tion was held on Jan. 27th at 3, Grosvenor-place, London,S.W., to consider plans to meet the requirements of theMidwives Act in the various rural and provincial districts,including the training and supervision of midwives, assist-ance from local associations, and other points connected withthe work. The chair was taken by Lord Belper, vice-chairmanof the County Councils’ Association. After two hours’ dis-cussion the conference came to the unanimous conclusionthat the requirements of the Midwives Act might be usefullymet by adding midwives to the staffs of the local nursingassociations and by training local women to work under asmall committee, provided that in both cases their work waskept distinct from cases dangerous to their calling. Wherelocalities were unable to meet the initial expense of trainingmidwives it was considered that recourse must be had togrants from county councils and others but some paymentby the patient ought always to be made to meet the currentexpenses. The conference further expressed its opinion thatrespectable women of the cottager class, carefully trainedand working under supervision, would meet the requirementsof the Act in rural districts. The last formal declaration ofthe conference was that the supervision of the local com-mittee was advisable in every case and that it should be incommunication with the local supervising authorities underthe Act. Dr. R. Boxall said that to avoid pauperisingthe class of people who used midwives a plan shouldbe adopted by means of which they should contributesome small sum to an institution for the payment ofa medical man if required. He considered it a verydetrimental practice to leave it to the midwife to callin a medical man when she thought it necessary andto reduce her fee when that occurred. He advised thatthe best of the women of the cottage class who had beenalready working as midwives in the rural districts should besought out and put through a suitable training. Dr. W. S. A.Griffith, physician to Queen Charlotte’s Hospital, pointedout that the work of the association was to assist in trainingthe midwives who were to practise in the rural districts.These women would be poorly trained and quite unable topay for their own training or to make a living from midwiferyunless they had homes of their own and were independentof their earnings. The association must not place a strangemidwife in a district and tell the people to go to her. Theymust take a woman from the district, train her, and then let

2 The appearances on dissection also are set out in THE LANCET ofFeb. 4th. 1826.

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!her work among those who know her. Midwives for the Irural districts must be trained in some less expensive method than obtained in the great metropolitan hospitals and yet they must be taught up to the standard of the MidwivesBoard. In his opinion the combination of elementarysmrsing, sanitation, cooking, with the preparation required,from midwives, was the training at which the RuralMidwives’ Association and all similar bodies should aim.Dr. F. R. Cassidi of Derby gave an account of howthey managed to set on foot a scheme for the training of,midwives for the rural districts at the cost of about Z20 fora year’s training. One of the ladies present spoke of thesuccess achieved in her district by supervising the work ofthe midwives through a local committee. Her remarks weremet by another lady from Scotland who said that her expe-rience was that the midwives were apt to supervise the local- committee and in the particular case to which she referredthe difficulty was met by appointing a fully trained andcertificated nurse to superintend the work of the midwives,- a. plan which answered admirably. Dr. Constantine Holmanin a few words persuaded the meeting to take his view thatit was most certainly advisable to recommend that local-committees should be intrusted with the supervision of thework in question.

ASYLUM REPORTS.

Hereford City and County Agylum, Burghill (Report for the year ending March, 31st, 1903).-The averagenumber of patients resident during the year was 453,eomprising 204 males and 249 females. The admis-sions during the year amounted to 161-viz., 67 malesand 94 females. Of these, 109 were first admissions.Mr. C. S Morrison, the medical superintendent, statesin his report that among the causes of insanity in the.admissions were senile decay, neuropathic heredity, andalcoholic intemperance in descending order of frequency." The remarks that have been made in previous years," addsMr. Morrison, " as to the unfavourable type of admissions inregard to prospect of recovery may be repeated." The

tendency among parochial officials and-authorities to sendto the asylum persons of unsound mind, especially thosesuffering from bodily disease and infirmity rather thanserious mental disorder, shows no diminution. Of the

.patients admitted during the four years 1900-03 "109Were from 60 to over 80 years of age, the great majorityrequiring infirmary care and treatment." The numberof patients discharged as recovered during the yearamounted to 29, comprising 15 males and 14 females, or6. 4 per cent. of the average number resident. The deathsduring the year amounted to 38, or 8’3 per cent. as calcu-lated on the same basis. Of the deaths, two were due to"epilepsy, two to pulmonary tuberculosis, three each to-cancer and general paralysis, five each to bronchitis, cardiac- disease, and senile decay, and the rest to other causes. An

epidemic of scarlet fever occurred in the institution andaffected 12 patients (six males and six females), 16 nurses,and two attendants. " That we had no death from scarletfever was fortunate, especially as the majority who suffered-were the younger members of the staff." Electric lightingwas decided upon as best for the purposes of the institution.and an electric installation has since been put up throughoutthe building. The Commissioners in Lunacy state in theirreport that all parts of the asylum were found to be in goodorder, that the wards were bright and cheerful, that the.-dormitories and bedding were clean, well ventilated, andwell-cared for, that the patients seemed comfortable andcontented. and that the medical case-books were well kept.The committee of management states in its report that thefarm and dairy are in a satisfactory condition and drawsattention to "the gradual extermination of tuberculosis inthe herd of dairy cows which has never been healthier thanat present." In consequence of the increased number ofpatients under care the committee has found it necessary toappoint a third medical officer to the institution.

lYilts County Asylum (Report for the year ending March31st, 1903).-The average number of patients resident duringthe year was 938, comprising 425 males and 513 femalesThe admissions during the year amounted to 162-viz., 73males and 89 females. Of these 137 were first admissions.Mr. J. Ireland Bowes, the medical superintendent, states inthis report that the number of hopeless and incurable cases

among the admissions continued to increase yearly, par-ticularly as unions no longer afforded the relief that theydid years ago. Hereditary predisposition and alcoholicintemperance were among the most important causes of

insanity in the admissions. 15 were epileptics and a

large proportion were said to have made attemptsat suicide. The number of patients discharged as

recovered during the year amounted to 45-viz., 15males and 30 females, or 4’8 per cent. of the averagenumber resident. The deaths during the year amounted to70, or 7’4 per cent. as calculated on the same basis. Of thedeaths three were due to cerebral softening associated withhemiplegia, three were due to bronchitis, four to epilepsy,eight to senile decay, ten to general paralysis of the insane,13 to cardiac disease, 17 to pulmonary and other forms oftuberculosis, and the rest to other causes. The cause ofdeath was verified by post-mortem examination in 54 cases.A male patient suffering from delusions of persecutionsecretly secured possession of an old razor thoughtlessly leftin an unlocked drawer in the room of a junior attendantand with this instrument he made a murderous attackon a fellow patient whose throat he attempted to cutwhen his victim was asleep. The injury was serious butdid not prove fatal. The health of tha institution has beengood throughout the year apart from the occurrence ofisolated cases of dysentery and erysipelas. The Com-missioners in Lunacy state in their report that the wardswere bright, cheerful, and clean, that the dormitories werewell ventilated, that the patients seemed physically in goodhealth and fair condition, and that the medical case-booksand records were particularly well kept. The committee of

management states in its report that a new detached blockfor female patients is in process of erection and that a newwaiting room and the isolation hospital have been com-pleted during the year. Owing to the continued high priceof most necessaries used at the asylum and to the increasein the rates the committee was obliged to raise the weeklyrate of maintenance per patient to 10s. 6d., as against 9s. lld.during the previous year.

MEDICINE AND THE LAW.

The Cold Weather and the Factory Acts.A COMPANY called the Ebnrite Paper Company, 35, Red

Lion-street, was fined £10 and 18s. costs at Bow-streetpolice-court on Jan. 23nd for failing to take measures forsecuring a reasonable temperature in its workrooms. OnDec. 31st, 1903, when, it will be remembered,.there was a spellof extremely cold weather, Miss Vines, a factory inspector,found women and girls at work in rooms upon the company’spremises, two of which were at 4Zo F. and one at 45°.The magistrate, Mr. Fenwick, characterised the offence as abad one of its kind, which it certainly was, and imposedfurther penalties of 40s. upon the same defendants upon eachof three summonses for employing girls under 16 years ofage without medical certificates of their fitness for employ-ment in the factory.

Street Loeontotives.Attention was recently called in THE LANCET to the

increased number of locomotives to be seen and, at night,heard drawing trucks through the London streets, to the

heavy weights allowed to be treated thus, and to theannoyance and disturbance caused by the resulting noise andvibration. Driven by sober men these engines are terrifyingto horses and consequently dangerous both to persons drivingand to foot passengers. A man in charge of such an enginedrawing a truck behind it was recently stopped by apoliceman after he had driven on the wrong side of a streetrefuge and had proceeded on his way at a rate described asabout seven or eight miles an hour. He was sentenced atClerkenwell police-court on Jan. 21st to a month’s imprison-ment and may consider himself lucky that he is not lyingunder remand on a charge of manslaughter.

Corporal Punishment and Crimes against Women.Grand juries frequently make presentments at country

assizes recommending legislation to enable rape and kindred! offences to be punishable by flogging, and this penalty was

actually ordered to be inflicted by Mr. Justice Darling in arecent case upon the Western--Giruuit--where the prisoner, by

; plea,ding guilty to an indictment charging him with robbery