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any physical signs of the condition. It is much safer to treat 1these cases as if they were subcutaneous traumatic rupture ‘of the blood-vessels. This, in fact, they are, the only Idifference being that the injured walls of the vessels give way Isome days or weeks after the original injury. I know of cases iin which the artery was tied above by Hunter’s operation-a tmuch easier operation-but they were followed by gangrene.As long as the large blood-tumour is .left it is a serious 1obstacle to the collateral circulation after proximal ligature 1of the main artery. j

INJURY TO THE INTERNAL SAPHENOUS AND GREATSCIATIC NERVES, WITH ANEURYSMAL VARIX IN HUNTER’S CANAL.

CASE 5.-A newspaper correspondent was shot through the. thigh on August 21st, 1900, near Belfast. When admitted

to the hospital the entrance wound and the exit wound 1in the front and at the back of the middle of thethigh were healing kindly with no evidence of sub-cutaneous extravasation of blood. There was absoluteanaesthesia over the distribution of the internal saphenous Inerve, with ansesthesia dolorosa over the middle two-thirdsof the inner aspect of the leg. There was also anaesthesia,but not complete ansesthesia, over the distribution of theanterior tibial and musculo-cutaneous nerves, but therewas no motor paralysis. The diagnosis arrived at wasthat the internal saphenous nerve had been divided inHunter’s canal, and that the outer edge of the great sciaticnerve-or, if it had already divided, the external poplitealnerve-was in. a state of paresis due to the hydro-dynamicalshock which I have already referred te, We were all

surprised that the blood-vessels had escaped, consideringthe nerve lesions and the position of the wound.On Sept. 4th-i.e., a fortnight after the aacident-ananeurysmal varix formed in Hunter’s canal, and on the8th I tied the femoral artery immediately above the originalinjury by separating the fibres of the sartorius muscle insteadof displacing it, which requires a longer incision. Recoverywas uneventful. The fact that a bullet can pass antero-posteriorly between the superficial femoral artery and thevem and divide its accompanying nerve without giving riseto immediate dangerous haemorrhage is almost on a par withthe surprising fact that perforations of the intestine willclose without the aid of a surgeon.

EXPLOSIVE OR EXPANDING BULLETS.

I saw but few cases of wounds which had been caused byexplosive or expanding bullets. In all of the cases the bonehad been shattered, and the few cases which suppurated,as well as the veldt sores, were treated by the application ofpure tincture of iodine.

I had the opportunity on arriving in Pretoria of examiningthe carriage of the American Consul-General, Colonel Stowe,which had been riddled by Mauser bullets south of Kroon-stad, and as our train was the next to go to Pretoria withpassengers after the line was repaired we naturally took alively interest in the character of the bullet-holes in the

carriage. There was one bullet-hole above the ventilator ofone of the windows which before a full examination I tookto be due to the effect of an explosive bullet. Between theinner and outer wall of the ventilator there was a space ofabout two inches. The outside had one clean-punched holewhich was the hole of entrance, whilst on the inside wallthere were six jagged perforations covering an area of sixinches by three inches. The bullet in traversing the inter-space between the inner wall and the outer wall struck athin piece of cast iron and was broken into six fragments,and it left behind in the space a piece of the outer covering.Everyone who saw the condition felt that it was undoubtedlyan example of the effect of an explosive bullet. Throughthe courtesy and kindness of Colonel Stowe and MajorGordon, Railway Staff Officer, I was allowed thoroughly toexamine the carriage and to make plain the use of what mostof us had considered to be a bullet which is not permittedin civilised warfare.

THE PROTECTION OF THE HEART IN BATTLE.Some members of our profession have for years advocated

the wearing of a steel breastplate for the protection of theheart in battle, but I am afraid that the experience gained inthis war with small-bore rifles is likely to damp their ardourin advocating the use of such a protective appliance. Aman is as likely to be shot through the heart by a bulletentering at the shoulder, the side, the back, the loin, or eventhe head, as he is to be killed by a bullet entering in front of

his chest. In fact, from all accounts I think that in thiswar the left breast was the least likely spot to reach theBoer’s heart by a bullet on account of his assuming the proneposition behind cover or protecting his chest in a trench.A man of Brabant’s Horse had a narrow escape of being shot’through his heart via his right ilium. He had just eatena whole Maconochie ration and bad started up the side of a

kopje immediately afterwards. Some Boers had managed toget round the hill and were hiding in a mealie-field ; theyfired and the bullet entered the trooper’s body at about twoinches below the crest of the right ilium and came outimmediately below the costal margin of the left eighth rib,probably having traversed his full stomaGh.

CONCLUSION.

In conclusion, I again wish to emphasise the opinion thatthe vis medicatrix natura of the old school will be found ina more prominent and exalted place amongst the methodsand means of treatment in penetrating gunshot wounds ofthe abdomen than it has been since the birth of the newoperative school a few years ago.On board Royal Mail Steamer Saxon, Oct. 17th.

NOTES FROM SOUTH AFRICA.

(FROM OUR TRAVELLING CORRESPONDENT.)My last letter was written en route between Norval’s Pont

(Orange river) and Kroonstad. At Kroonstad I have beenobliged to stop for a day, but I hope to leave for Pretoriato-morrow and thence to take a run down to Durban.The small stations on the line between Bloemfontein and

Kroonstad-Glen, Karee siding, Vet river, Smaldeel, andVentersburg road-,have each a civil medical officer incharge, with a small marquee hospital of from 10 to 30 beds.Here trivial cases are treated till the men are fit for duty,while serious cases, which are very few and far between, aresent down the line in ambulance trains to Bloemfontein.Winburg, some 20 miles from Smaldeel, with which it com-municates by rail, has a large stationary hospital of 150 bedsin town buildings. This hospital, under Major Hamilton,R. A.M. C., has had a busy time, as it has been the medicalcentre of a large tract of country-the Ficksburg, Bethlehem,and Senekal districts-which was for several weeks the

scene of constant fighting with small marauding bands of theenemy.The whole country between Bloemfontein and Kroonstad

is inexpressibly dreary-wide stretches of sandy veldtsparsely dotted with kopjes and to all appearance unpopu-lated. September is the windy month in South Africa andour journey up was made in the teeth of violent sandstorms.The hot weather is now setting in, and the flies constitute averitable plague. It is difficult to exaggerate the potentialityof these pests to spread infectious diseases, and all medicalobservers of the typhoid fever epidemic in Bloemfontein lastspring are agreed in believing that flies were an importantagency in spreading the disease. Mosquitoes are commonenough in houses, but they are practically unknown in

camps. I have caught several specimens, but have not yetseen the anopheles claviger or malaria-bearing variety.

Kroonstad is a miserable little town of tin-roofed houses

straggling from the eastern side of the railway station to theValsch river. Streets alternate with waste plots given overto Kaffirs, empty tins, and general rubbish. Close to thestation is the tiny hotel, now converted into a neat little

,

hospital for officers, of whom there were four, who were con-valescents, waiting there for a hospital train at my visit.

, Near the hotel is the church, a tin-roofed building with ar wooden floor. Both these buildings were used for the, temporary reception of sick soldiers when Kroonstad was

first occupied and both were the subject of unfavourableI comment by Mr. W. Burdett-Coutts who appeared to thinkl that beds should have been sent into the town for the recep-I tion of patients before our forces occupied it.

In marked contrast to the sordid, dreary little town arethe camps on the western side of the station-No. 3 General

l Hospital, the Scottish Hospital, and the convalescenti camp attached to No. 3 General Hospital. All thesei are close together and occupy an excellent site on a

gentle eminence sloping down to the line. No. 3 General. Hospital is a typical example of the best classj of marquee hospital. The lines are laid out witht marvellous accuracy, the interiors of the marquees are neat, and cheerful, and the patients appeared to have every

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comfort, including large double recreation and dining tentsfor convalescents. A grim reminder of war is the bomb-

proof shelter between the hospital and the line, and it isnot so long since that convalescent patients had to man thetrenches in view of an expected attack by the notoriousDe Wet. Near to No’. 3 General Hospital, but separatedfrom it by the convalescent camp, is the Scottish Hospital,which consists of 20 tortoise tents which accommodate 200patients, with several wooden huts used as administra-tive buildings. The general plan of the hospital is

lacking in the symmetry and severe simplicity con-

spicuous in purely military hospitals, but the wards arecheerful and neatly kept, and nothing that human ingenuitycould devise for the actual care and comfort of the sickhas been forgotten. The services of the surgeons of this

hospital have been requisitioned for an unusually largeproportion of serious surgical cases, and they have beenmarkedly successful in cases of intestinal suture and resec-tion. I understand that this hospital has just been handedover to the Government, and I only hope that the services ofsome at least of its brilliant staff have been retained. Bothof these hospitals have many vacant beds ; in fact, thehospital arrangements all through South Africa-calculatedas they are for a fighting army in an unhealthy country-areon far too lavish a scale for present circumstances, and themedical officers and the nurses everywhere report a lack

of work.Kroonstad, Sept. 28th.

WATER-SUPPLY IN SOUTH AFRICANTOWNS.

(FROM A CORRESPONDENT.)

THE following notes, which we have received from a

correspondent well situated for knowing what he is writingabout, show that the question of water-supply in SouthAfrica is still in its infancy and that drainage schemes asyet hardly exist.

CAPE COLONY.

Cape Town possesses a gravitation supply under the controlof the corporation. There are two large reservoirs on TableMountain to collect the rain, of which there are as much as100 inches in the year. The neighbourhood of the reservoirsis jealously guarded and is free from all possibility of humancontamination. This town is the only one in South Africawhich is thoroughly drained.Among the suburbs we have Wynberg, which also gets its

supply from Table Mountain. Here there are two reservoirsand the authorities are considering the question of drainage.At Rondebosch and Claremont there is a spring water-supply,but it is not sufficient for the rapidly-increasing number ofresidents, and is recognised as being imperfect, so that anew scheme is under consideration, but there is as yet nodrainage. At Kalk Bay there is a gravitation supply fromreservoirs, without drainage. At Simonstown there is a

water-supply from the mountain for naval and military,purposes and in the town there is a storage reservoir fromsurface springs, but no drainage. At Burgersdorp thereis a gravitation supply from springs five miles away acrossundulating country, while at Somerset East there is again.a gravitation supply in addition to an irrigation supply,because water is collected in a catchment area in the hillsand allowed to run down to the town in irrigation channels.At Caledon there is a gravitation supply, with a reservoir and,a catchment area on the hill, all very good in spite of theabsence of drainage. At Port Elizabeth, a town which hasthe distinction of being already half-drained, there is a

.gravitation and pumping supply of water from a catchment

.area situated in the hills 18 miles away from the town.Here there is a filter-bed from which the water flows in

covered pipes to one of the most enterprising towns in SouthAfrica. At East London there is a similar excellent water-supply but no attempt at drainage.

ORANGE RIVElt COLONY.

The only town in this colony boasting of a water-supply isthe well-known capital, Bloemfontein, where there is a pump-ing supply from the Modder river, 22 miles away, where the

water is filtered and then pumped into the ,town’. Nowthe Orange Free Staters were driven unwillingly to the

expense of new waterworks because the town suffered somuch every year from enteric fever. The town takes itsname from Bloomfountain, a spring in the centre of the town,which though once considered to be perfect has of late yearsbecome more and more contaminated by the filthy habits ofthe people, by neighbouring cesspools, and by the completeabsence of all drainage. ,

When the British so unfortunately allowed the Boers torepossess themselves of the Bloemfontein waterworks itwas from the condemned springs in the middle ofthe town that our army was obliged to draw its drinkingwater. It will be remembered that the British enteredBloemfontein on March 13th, bringing with them numbersof young soldiers who were already harbouring the seeds ofenteric fever contracted from the polluted water of Paarde-berg and other camps. The troops were still fatigued afterCronje’s surrender on Feb. 27th and the ensuing forcedmarches, and the bridges behind the advancing army had beendestroyed by the enemy, so that it was impossible to get upa sufficiency of food, much less Berkefeld or Pasteur filters.Moreover, in the complete absence of fuel and with stringentorders not to interfere with the residents, it was impossible

! to boil the men’s drinking water. Added to all this therecame unfortunately at this time some heavy rain whichmust have washed much surface-dust and many typhoidbacilli into the drinking wells. To complete the picture,it must be remembered that the army had not had time toerect latrines and that the rain showers had every oppor-tunity of washing the bacilli into the wells where every-thing necessary existed for the production of artificialcultures.Assuming that these various causes aided, with others, in

producing the typhoid fever epidemic the concentration of thepoison at Bloemfontein was to be expected about the end ofMarch, and allowing for two weeks’ incubation and three or

L four weeks’ illness the death-rate from disease in Southr Africa would presumably mount ap about the middle of’

May. As a matter of fact, the death-rate from disease1 reached the high figure of 206 in the week ending April 28ths and rose to 311 in the week ending May 19th, while it

reached its maximum of 369 in the following week. I havegone into some detail on this point because it has alwaysseemed to me that the chief defence of the Royal Army

l Medical Corps with regard to the typhoid fever epidemic atB Bloemfontein might be the carelessness of the authorities

who permitted the Boers to take possession of the onlys waterworks in the Orange Free State.1 Is it too much to hope that some day a general officerL while invading the enemy’s territory will inform himself of

the water-supply of any town which he is attacking ands safeguard it at all costs? During the present war thiss would have been extremely easy, for the headquarters staff- could have obtained all information from one or both of the. two water engineers who have constructed most of the water-

works mentioned in this article.

THE TRANSVAAL.1 Johannesburg possesses a water supply which comes from aL farm 22 miles outside the town, shafts being sunk 18 feet into7 the dolomite limestone rock, and the daily yield is 1,000,0001 gallons. This belongs to a private company. Johannesburghas no drainage yet, the daily removal-bucket system beingS in full force, worked by Kaffir coolies who are obliged to1 live in a special part of the town. The Johannesburg water-’ works have more than once been nearly captured by theS Boers since our occupation of the town.- Pretoria, although the capital, is a much smaller and less1 important town, and possesses a very excellent water-supply,e though it is wholly dependent for drainage on buckets ands Kaffirs. The water comes from a spring situated in a’I. picturesque ravine between two of the hills commanding thetown, upon the summits of which are built the empty forts1. which were supposed to defend the capital. There seems no1 possibility of pollution, for there is only one farmhouse near1 by and both the intake and the pipes to the town are well-

protected. Chemical and bacteriological analysis were veryfavourable in August, when examined by Dr. G. Turner, themedical officer of health of Cape Town, who hs now beenlent to the Transvaal. Moreover, the quantity of water is

s quite enough for 50,000 people and therefore it is ample for- the 15.000 inhabitants of Pretoria.3 Cape Town, September, 1900.