843

EDWARDS, E. P., L.R.C.P.Ed., L.F.P.S.G., L.S.A.L., has been appointedMedical Officer of Health for the Anglesey United Sanitary Districts,comprising the Anglesey Rtiral, the Holyhead Rural, the BeaumarisUrban, and the Holyhead Urban, Sanitary Districts, at J6200 per annumand private practice.

GATEHOUSE, Mr. J. W., has been appointed Public Analyst for Bath,GoOD, Mr. F. T., has been appointed Assistant House Surgeon to the

Derbyshire General Infirmary, Derby, vice Prideaux, appointed ResidentMedical Officer to the Small-pox Infirmary, Derby.

GRAY, F. A., L.R.C.P.L., M.R.C.S.E., has been appointed Medical Officerfor the Newton-Poppleford District of the St. Thomas Union, Exeter,vice Cos, resigned.

HEALY, illr. G. H., has been appointed Assistant House Surgeon to theWest Sussex, East Hants, and Chichester Infirmary.

HEATH, C., F.R.C.S.E., has been appointed Consulting Surgeon to the DentalHospital of London, vice De Morgan, deceased.

JAMES, J. R., M.B., M.R.C.S.E., has been appointed Medical Officer to theTylacock Colliery, Pentre-Rhondda.

JENKINS, J., M.R.C.S.E., L.S.A.L., has been appointed Medical Officer forthe Western District of the Bridgend and Cowbridge Union, Gla-morganshire, vice Allen, deceased.

LEESON, J. R., M.B. &c., has been appointed House Physician to St.Thomas’s Hospital.

LEYS, P., M.B. & C.M., has been appointed Acting Colonial Surgeon atLabuan, and Medical Officer to the Oriental Coal Company of thatisland. Also Member of the Legislative Council of the Colony, and oneof the Custodiers of the Colonial Treasury.

MCDONNELL, J., L.R.C.P.Ed., L.R.C.S.I., has been appointed MedicalOfficer &c. for the Killashee Dispensary District of the Longford Union,vice Slevin, resigned.

MACK, J. S., L.R.C.S.Ed. & L.M., has been appointed Medical Officer andPublic Vaccinator for the Lower District of the Parish of Colmonell,Ayrshire, vice Cochrane, resigned.

MiLLER, A., L.R.C.P.Ed., L.F.P.S.G., has been appointed Out-door Physician-Accoucheur to the Glasgow Lying-in Hospital for the Eastern Districtof the City, vice Hunter, deceased.

RULTON, T. C., M.B., F.R.C.S.E., has been appointed Medical Officer ofHealth for the Withington Urban Sanitary District.

RANKIN, P., M.D., has been appointed Certifying Factory Surgeon for theDistrict of Airdrie, Lanarkshire, vice Torrance, deceased.

ROBERTS, A. C., M.R.C.S.E., L.S.A.L., has been appointed a ConsultingSurgeon to the Exeter Dispensary, on resigning as Surgeon.

SPOONER, F. H., L.R.C.P.L., 2-I.R.C.S.E., L.S.A.L., has been appointedAssistant House Surgeon to the Royal Albert Edward Infirmary andDispensary, Wigan.

WILSON, R., L.F.P.S.G., has been appointed Certifying Factory Surgeonfor the District of Coatbridge, Lanarkshire, vice Torrance, deceased.

Births, Marriages, and Deaths.BIRTHS.

GRELLET.—On the lst inst., at Hitchin, the wife of Charles John Grellet,M.R.C.S.E., of a son.

HARRISON.—On the 24th ult., at Fairfield View, Ambleside, the wife ofRobert Harrison, M.B.C.S.E., of a daughter.

McCONOCHIE.—On the 1st iust., at South Portland-street, Glasgow, thewife of James MeConochie, M.D., of a daughter.

PLATT.—On the 1st inst., at Priory Villas, Kilburn, the wife of W. H. Platt,L.R.C.P.Ed., of a daughter.

WEIR.—On the 1st inst., at St. Mungho’s, Great Malvern, the wife ofArchibald Weir, M.D., of a son.

WILKINS.—On the 21tli ult., at Chittoor, the wife of Thomas JamesHackett Wilkins, L.R.C.P.Ed., Surgeon Madras Army, of a daughter.

MARRIAGES.DE LA COUR—TOORE.—On the 30th ult., at St. Matthew’s, Oakley-square,

George Francis De la Cour, M.D., to Julia Terry Southmeade, daughterof the late Rev. Henry John Tooze.

ELLIOTT—RUTTLEDGE.—On the 23rd ult., at St. George’s, Bloomsbury,Henry George Elliott, L.R.C.S.L, to Mary Withers, daughter of the lateT. Ruttledge, Esq.

OUGHTON—DERRETT.—On the 27th ult., at St. Lube’s Church, by the Rev.T. W. Norwood, Tyler Oughton, Army Medical Department, to EmmaDerrett, eldest daughter of the late G. Derrett, of Gloucester.

DEATHS.ARTHY.—On the 39th ult., at Fincham, Norfolk, Edward Arthur Arthy,

L.S.A.L.FORREST.—On the 29th ult., at Broomey-hill, Hereford, Dr. Charles Forrest,

aged 82.GIBSON.—On the 19th ult., at Middlesborough, William Gibson, M.R.C.S.E.,

aged 25.HARVEY.—On the 5th inst., at George-street, Hanover-square, William

Harvey, F.R.C.S.E., late of Scho-squarc.LITTLE.—On the 26th ult., at Siltton-Benger, Wilts, Edward Moore Little,

L.R.C.P.L.LOFTUS.—On the 17th September, at Wa.rrna.mbou], Victoria, William

Loftus, M.D., formerly of Glasgow, aged 39.MANNINGS.—On the 28th ult. at Downton, Wilts, George Mannings,

M.R.C.S.E., aged 33.-MAyo.-On the 27th ult., at Winchester, Charles Mayo, F.R.C.S.E.,

aged 87.PARKER. — On the 30th It., at Sheffield, Samuel Parker, F.R.C.S.E.,

aged 57.Ross.—On the 19th ult., at Bombay, John Halyburton Ross, M.B., Surgeon-

Major, Army Medical Department.YARROW.—On the 1st inst., at Old-street, E.C., Anne, the dearly-loved wife

of George Eugene Yarrow, M.D., aged 32.

[N.B.—A fee of 58. is charged for the insertion of Notices of Birthe,Marriage, and Deaths.]

Notes, Short Comments, and Answers to Correspondents.

INSURANCE OF INFANTS BY FRIENDLY SOCIETIES.THE first Annual Report under the Friendly Societies Act of 1875 has beenissued by Mr. Ludlow, the chief registrar. The important question of theinsurance of infants by these Societies is dealt with at some length in thereport. It is stated that the clauses of the recent Act which enacted thatno money should be paid by any Society without the production of aspecial certified copy of the entry relating to the death in the death-register, "has brought out the fact that the insurance of children beyondthe legal limits has been practised in the manufacturing districts to anextent which the chief registrar feels himself justified in calling enor-mous." It is especially stated that sums far in excess of the cost of burial .have been paid in Lancashire and Yorkshire. It may be presumed that’these payments were made before the Act came into operation, althoughit is reported that a system of evasion of these restrictive clauses is beingattempted to be introduced. Such a matter is, as Mr. Ludlow suggests,one of sufficient importance again to occupy the attention ot Parliament,if the Act of 1875 becomes on this point in any way inoperative. We donot, however, see the necessity for waiting until it be definitely ascer-taiued whether or not burial insurance does affect infant mortality."Excessive insurance of infants is dangerous, to say the least of it, andshould be put down, without regard to the possibility of conclusivelyproving its direct effect upon infant mortality.

Mr. G. Jenner.—We never recommend a particular physician or surgeon.

A MIDWIFERY CLAIM IN COUNTY COURT.

To the Editor of THE LANCET.

SIR,—I am advised to forward you particulars of a County Court case.The facts are as follows.

I had been engaged to attend Mrs. B-, of this place, in her confine-ment, residing within 200 yards of my residence. On the evening of the9th instant I had notice to be in the way, as her labour was commencing.I was not called up in the night, but saw her the next morning at 11 A.M.1 then ascertained the membranes had ruptured in the night, and herlabour was progressing slowly. At 3 P.M. I was called upon to attend, andfound the os uteri fairly dilated, with the pains lingering. I stayed with hera couple of hours, and then suggested to the patient and her mother (thelatter a midwife) that I might leave the case for a time, and in the interim,when required, they could readily send for me again. This they willinglyconsented to do. I was kept waiting at home for some long time, and onreturning to the house I was told the woman was confined soon after I left,and they refused payment.Hence the summons in the County Court on the 20th instant, when, to

my surprise, the Judge ruled, as I had contracted to attend the patient inher labour, and having absented myself, she being delivered by the midwife-who in her evidence stated within a quarter of an hour after I had left thehouse,-that judgment should be given for the defendant with costs. Theremark by the Judge was that I had no business to leave the patient.Now, Sir, under the circumstances, my being kept in waiting all night (by

notice) and nearly all the next day, being prevented from attending myordinary duties, surely this is a hard case for the doctors. It can be neitherlaw nor equity. This is the opinion of my medical friends, and the remedyappears now that we must obtain our fees beforehand.

I shall feel much obliged if you will kindly state in the forthcomingnumber of THE LANCET your views and opinion on the question.

I remain, Sir, your obedient servant,JOSEPH PACKARD, M.R.C.S.E., &c.

Wrentham, Wangford, Nov. 28th, 1876.*** Our correspondent’s case is a very hard one. His willingness to attend

closely to a tedious labour-one of the most irksome duties of practice-was clearly shown by his patience, but was poorly appreciated by theJudge of the County Court. What is more surprising is that it was notbetter appreciated by the midwife and her daughter. Of course it would

have been well, as it happened, if our correspondent had been present atthe birth of the child. So he would have been if he had been duly sum-moned. The Judge should also have remembered all the trouble Mr.Packard had with the case, the uncertainty of tedious labours, theanxiety of medical men about other patients, and, last, the fact that themedical man had been of great service in ascertaining the natural cha-racter of the labour, and so assuring the patient and her friends. Thecase was not a good one for the County Court. It is evidently too muchto expect County Court Judges to appreciate the nature and difficulties ofmedical practice. But good patients should, and when they do not, apractitioner, as in the present instance, is to be congratulated on anoccurrence which interrupts his professional relations with them.-ED. L.

One of the Unqualified.-We cannot advocate a special examination for thosewho have "got rusty" in their knowledge. Men must make up theirmmds to pass proper examinations before getting rusty, and, failing thisto repolish themselves.

A CORRECTION.To the Editor of THE LANCET.

SIR,—In my communication on Hey’s and Lisfrane’s operations, pub-lished in THE LANCET of Dec. 2nd, I inadvertently stated that the secondedition of Mr. T. Smith’s " Manual of Operative Surgery on the Dead Body"had been "revised entirely by Mr. W. J. Walsham." I should have said" entirely revised by the author and Mr. W. J. Walsham."

Believe me, Sir, yours faithfully,Royal College of Surgeons, Dec. 5th, 1876. ALBAN DoBAN.

844

THE HOBSE PLAGUE IN EGYPT. IRRESPONSIBLE HOMICIDE.

THE Veterinary Journal, in an article on this subject, quotes from a report by WILLIAM DEANT, convicted at the Lincolnshire Assizes of murdering aDrs. Bull and Fenger, of Cairo, from which it would appear that various man named Gcll, and now lying under sentence of death, is clearly acontradictory opinions are held in Egypt as to the nature of the affection. victim of disease. There is a distinct history of epilepsy in his case, andSome speak of it as an anthracoid typhus, others as a diphtheritic malady, the fact that what are popularly called "fits" had not recently occurredand others as a kind of croup. But Drs. Bull and Fenger do not corrobo- only increases the probability that his offence was committed in one ofrate any of these opinions. They found neither diphtheritic nor croupous those uncontrollable outbursts of fury which are characteristic of thepatches; neither did they discover the spleen to be enlarged ; and that epileptic disease. When the "fits," which resemble storms working offit was not an anthracoid malady they endeavour to demonstrate by the the electricity surcharging an atmosphere, do not occur, or when theyfact that the lymphatic glands were not affected in any way, neither were are not promptly established, the pent-up force vents itself in a paroxysmthere bacteridia in the blood. They only saw in it an infectious malady, of impulsive rage, or "madness." The absence of motive is generally aa poisoning of the blood, the effects of which were localised in the re- characteristic of the crime perpetrated under this morbid influence. In

spiratory organs, as a catarrh of the pharynx, larynx, trachea, bronchi, this case the outbreak was preceded by unequivocal symptoms of sup-with multiple lobular pneumonia and apoplexy of the lungs. The disorder pressed nervous excitement of a distinctly morbid type. These werewas marked by "dissolution of the blood," with ecchymoses everywhere trembling, cold, sickness, and a sensation of "dying," which in them-in the respiratory organs, as well as in the pericardium, colon, and selves constituted an abortive "fit." Had a convulsion of adequate in-mesentery, with parenchymatous alterations in the liver, heart, spleen, tensity and duration occurred, the homicidal outbreak would probablykidneys, and mucous membrane of the intestines. All the cases in which not have supervened. To hang a man so afflicted would be as irrationalautopsies were made presented the same characteristic alterations. Our as to take a fever patient out of his bed and punish him for some offencecontemporary notes that it is reported the disease has broken out in committed under the influence of delirium.Western Africa, and that steps have been taken to prevent its introduc- W. C. A.—We shall be pleased to publish them in any form our corre-tion to Gibraltar, spondent may choose. Perhaps they had better be grouped as suggested.

W. G.—The subject will be discussed on general grounds next week. Mr. J. O’R. must consult a general practitioner.

PASSAGE OF A FOREIGN BODY THROUGH THE ALIMENTARY CANAL. MILITIA SUITGEONS.

To the Editor of THE LANCET. To the Editor of THE LANCET.

SiB-The following case may prove interesting, although, from its SIR,—" Militia Surgeon," in your last impression, draws attention to the

happy result, the details are few. fact that Mr. Hardy now repudiates iu toto the claim of militia surgeons to

About 9 P.M. on July 23rd last I was hurriedly summoned to see an infant, compensation for loss of income under the new Warrant. Although Parlia-

aged eight months, who was stated to have swallowed a safety-pin, such as ment granted redress to line officers under their altered condition, and,is commonly uspd in the nursery. The pin, when last seen, was open, and more recently, the adjutants of militia received an increase of pension bythe point therefore unguarded. I found the child, a fine healthy girl, way of compensation to induce them to retire, the militia surgeon is to getbleeding slightly at the mouth, and screaming violently. On discovering no consideration; yet his private practice in many cases has been littlewhat the child had done, the mother at once opened the mouth, and, as she more than nominal, in consequence of absence from head-quarters severalbelieved, forced the pin down the child’s throat, for she said she distinctly days a week on recruiting service; and absence in like manner has beenfelt the pin at the baok of the fauces. I made gentle examination with my little detrimental to his interests by disqualifying him for local public appoint-finger, and then, finding nothing, passed down a small pair of blunt forceps ments. Take away nine-tenths of a man’s income for no fault of his, andwithout feeling any foreign substance. I administered two or three tea- then tell him he has not sufficient grounds" to entitle him to com-spoonfuls of salad oil, which were swallowed without any apparent difficulty. pensation, forsooth ! Opportunity to acquire private practice is preventedAs the child gradually ceased crying, I ordered perfect rest, and in a very where the militia surgeon is on duty frequently far from his home, and heshort time she slept. Doubts then arose in my mind as to whether the pin is known only in his locality as the militia doctor, and as such it will take ahad ever been swallowed. The slight haemorrhage from the mouth might lifetime to shake off the incubus; yet he has no claim to compensation!have been caused by the mother’s hasty examination ; a fingernail abrading The majority, it not the whole, of the militia surgeons who have signifiedthe delicate mucous membrane would suffice. The infant slept on, and in their wish to be placed on the departmental list are not deluded by thatthe morning two teaspoonfuls of castor oil were given, and a dose of mucila- ignis futuus," increase of pay and rank," but have so acted simply to main-ginous mixture every two hours. Strict injunctions were given to watch the tain a locus standi in the service, for the sake of obtaining compensation, tostools; but from the time I left the house nothing transpired. About a which all of us deem ourselves entitled. This course has been taken in eon-week after the occurrence the lady was obliged to return home to Ireland, sequence of Mr. Hardy, in the House of Commons, having stated, in replyand I heard nothing more of the case until the end of September, when I to Dr. Playfair, that "he did not know how many militia medical officersreceived the plea,ing intelligence that on September 23rd, exactly two would accept the new terms, &c.," thus rendering his intentions doubtfulmonths after swallowing the pin, the child passed it in its morning stool, regarding those who stood aloof. It is now ascertained that those whowithout the slightest pain or uneasiness. Throughout the whole time accept the terms of the new Warrant will not be disqualified thereby forthere had been-no traces of blood in the motions, and not one untoward receiving compensation. What is in store for those who decline to enrolsymptom. The pin was extensively oxidised, but the point still sharp. It themselves in the departmental list ?is now in my possession. I am, Sir, your obedient servant,That such a dangerous little weapon could safely travel the entire alimen- Dec. 1876. ANOTHER MILITIA SUBGFON.

tary canal, from mouth to anus, without a single symptom, I think deservesa record in medical history. Yours truly, DECAY OF THE TEETH.Great Portlaud-street, Nov. 29th, 1876. ARTHUR H. W. AYLING. THE American Journal of Dental Science states that Dr. L. B. Palmer, of

A COllntry Surgeon.—The answer to our correspondent’s question turns New York, has been led to conclude, from a series of experiments, that

upon the nature of the circumstances and the way in which the fracture the decay of the teeth is not, as is generally supposed, due to acids, but

was occasioned. If in a way not possibly involving the idea of blame to to alkalies. With the latter he reproduced decay of the teeth as it is

any second person, or carelessness in any public service, an inquest would seen in the mouth, but was unable to do so with acids. With the assist-

seem unnecessary. The best way is to state the facts, so as to leave the ance of an electric current acids simply acted on and destroyed the whole

responsibility of having or not having an inquest with the coroner. of the enamel.

Mr. W. Williarms.—Apply to the Secretary of the College. A. Z.-A résumé of the report of the Commission appointed to investigatethe whole subject connected with snake-poison, and the remedies sug-

ERGOT IN THE TREATMENT OF ACUTE RHEUMATISM. gested for it, was published in THE LANCET for Sept. 19th, 1874.To the Editor of THE LANCET. C. T. A.-It is not easy to advise our correspondent as to his remedy but

SIR,— This letter is not written with the intention to throw discredit on certainly it is never wise to sign a receipt until the money is obtained.the use of salicin or any other remedy in the treatment of acute rheumatism,but merely to state that which I know to be the fact. COFFEE versus ALCOHOL IN CoLD.

I have almost invariably used ergot in cases of acute rheumatism, and in To the Editor of THE LANCET.no one single instance have I known it to fail. The recoveries have been SIR,—I am frequently compelled at this season of the year to have menrapid and complete, which is a great thing in its favour, and neither have I working in water, even in frosty weather. I find the following allowanceknown any heart symptoms arise during the attack or after recovery. I have had opportunities of testing its efficacy in various parts of England gives great satisfaction to the men, and we never have a case of cold orand the West Indies, and have found it of great utility in both climates, the injury to the men in any way:—Kettle of coffee, made with half sweet milk,recovery being as complete in one as in the other. Of course I need hardly half water, three or four eggs (whisked) poured into it when it is off thestate that I have used salicin, including various other remedies ; but I boil; hot toasted bread, with plenty of butter of the finest quality. Servehave found them very inferior in their action to ergot. I certainly think up this every two and a half hours. Let the men go straight home fromthe great object in the treatment of acute rheumatism is to prevent heart their work, put on warm woollen drawers and stockings; add a very smallcomplication arising, and I am certain, as far as my experience goes, ergot extra allowance in money to their wages for being wet. The result is that,acts as a preventive to such. The next best remedy, in my opinion, is the even at this season of the year, no injury has ever happened to any of oursomewhat antiquated mixture containing the sulphate of magnesia, car- men from working in the river. The expense is much less than the usualbonate of magnesia, and colchicum, which I have used with great benefit to allowance of whisky, and the men work far better, and, if care is taken tothe patient ; but the progress towards recovery has been slow. When I was have the coffee, milk (cream is better still), bread, and especially the butter,a student at Guy’s Hospit al, where every method of treatment is given a fair of the very finest quality, the men are delighted with it. On railways, wheretrial, I observed that those cases which were treated by ergot recovered very cold, hard work and overtime must sometimes be wrought, at docks,more rapidly than those which were treated otherwise. It is perfectly cor- and in camps, I am persuaded that it would be worth while to try thisrect what Dr. Curnow stated, "that the treatment of acute rheumatism is allowance instead of grog. What is the honest opinion of the profession inso varied and unsatisfactory that any new method or novel therapeutic regard to the Arctic expedition ? Suppose no spirit of any kind had everagent is sure of attracting much attention." been used, would the health of the men have suffered ? Giving extra grog

I should have written more fully on the treatment of this painful malady, gives the men the notion that it is good for them, and perpetuates thebut I did not wish to take up too much space of your valuable journal. belief in stimulants among working men.

I am, Sir, yours obediently, I am, Sir, yours &e.,Camberwell-road, Nov. 27th, 1876. E. M. BODDY, F.R.C.S., &c. November, 1876. AN OwNER OF WATER-POWER MILLS.

845

THE CENTENNIAL FEVEB made-this an hour after the hemorrhage had been almost entirelyMuch controversy has taken place regarding the nature of the sickness that arrested,-the result being that the bleeding returned more severely than

before. The os being then soft and dilatable, I at once made a plug ofwas undoubtedly prevalent at Philadelphia during the Centennial exhibi- my hand, ruptured the membranes, brought down the legs, and delivered intion, the cause being generally attributed to the defective sanitary con- that instance. Mother and child both did well. In one case, during mydition of the City. One writer is convinced that the disease depended on absence from home for a short time, my assistant had been with the casefever-contaminated articles which had been brought from plague spots in about three hours previous to my arrival, during which time the loss hadEgypt, India, Africa, and South America. Theae had been taken out of been severe. The oa being very slightly dilated, he had recourse to pluggingEgypt, India, Africa, and South America. These had been taken out of until my arrival. The pains, however, were strong, and the labour duringboxes and placed on exhibition for months in poorly ventilated buildings. the time had made progress, so that I was enabled without much delay toHere, in his opinion, is sufficient to account for all "the obstinate typhoid deliver by at once rupturing the placenta, and bringing down the legs.states of the system we have witnessed," and he predicts that one of the Unfortunately, however, it happened to be a case of twins, and immediately

t- on the birth of the first child there was a sudden and severe gush, but

consequences of the Great International Exhibition will be the acelimatisa. which immediately first on rupturing the membranes of the second, .

tion of a hitherto unfamilliar type of fever in the United States. Another which was slowly extracted, pressure being kept over the uterus duringwriter thinks the mischief to lie in the contiguity of a certain cemetery its expulsion, afterwards giving a full dose of ergot to cause speedy con-to a body of water traction. Under the influence of nourishment and stimulants the womanto a body water . seemed to rally, the body becoming warm, and she expressed herself as feeling

Dr. R. Morgan.—Our correspondent’s qualifications are very good, and, if comfortable, and I had hopes she would have done well, a slight loss havingin England, he would, doubtless, find ways of getting into medical work as taken place about four hours after her delivery. She gradually sank, andan assistant or locum tenens or, in a new neighbourhood, by the simple died about six hours afterwards, In thia case both ehildren were saved.an assistant or locum tenens, or, in a new neighbourhood, by the simple Even in complete placenta prævia each case will have its own specialexpedient of commencing practice. merits, requiring a modification of treatment according to its own circum-

stances. As, however, I have only lost the one twin case, I can add myABSCESS AND LIPOMA. testimony to those who advocate the separation of the placenta from its

To the Editor of THE LANCET. attachment to the cervix in a circular zone as far as the finger can reach. If

Si , a endant to Mr. William Hardman’s letter on Abscess and the labour has not progressed so far as to make version and delivery easy,SIR—As a pendant to Mr. William Hardman letter on Abscess and it will in all probability arrest the haemorrhage, so as to give time, and, if so,Lipoma in your issue of the 25th ult., and also to your own remarks in a turning will be much more easy if the membranes are left intact, should suchpreceding number on the same subject, permit me to state that, when in a procedure become necessary. I have several times given ergot; but, likeLondon last February, I had the advantage of seeing Mr. Bryant operate on " g, P.," have not found any effect until after delivery, when a full doseseveral occasions in the theatre of Guy Hospital ; and, before removing a has appeared to contract the uterus more firmly and effectually, and diminishlipoma from the forearm of a female patient, he mentioned, in alluding to any further loss, which the patient would be badly able to bear.the difficulty not unfrequently experienced in distinguishing fatty from ’ ’

I am Sir yours truly,other tumours, that by freezing the growth we can easily ascertain if it is Eastbourne, November, 1876.

’

Gzo. MUNDIE M.D.fatty in its nature (a fact he subsequently demonstrated to his class), as no substance will freeze so rapidly as fat. The idea commended itself to me as To the Editor of THE LANCETan eminently felicitous one, and I noted it for my future guidance, afford-

.

ing as it does an approximate solution of an interesting problem by SIR,—In reference to "H. P.’s" case of placenta prsevia, permit me to in-mmimising the difficulty in establishing the diagnosis of lipoma in certain form him, through the medium of your valuable jonrnal, that from mysituations. c.

I am, Sir, yours, &c., experience I think it would have been better in his case to have used gentleH.M.S. Shah, Spithead, Dec. 3rd, 1876. MARCUS ALLEN, Surg. R.N. manual dilatation of the os uteri (some practitioners object to this mode ofTHE LIEBIG MEMORIAL treatment, on the ground that you are liable to tear the os; but I have re-

GIESSEN and MUNICH have, it appears, been disputing for precedence in the sorted to it several times without bad result, and with decided benefit) ; andif this had not the desired effect, Dr. Keiller’s or Dr. Barnes’s air dilator,

honour of possessing the monument of the famous chemist; the former combined with abdominal kneading, would have had the desired effect. Iffounding her claim on the fact that from her University Liebig’s fame the uterus remained obstinate, and did not respond to these means, thefirst issued to the world; Munich asserting priority because she formed forceps might have been used. Permit me to cite a similar case which oc-

the scene of the Baron’s labours during the later years of his life. Happily curred to me a year ago.was called out suddenly to see a married woman, aged thirty-five, who

a compromise has been practicable, the liberality of the subscribers to the was attended by a certified midwife. She had six children, all of whom hadmemorial having resulted in the collection of a sum (140,000 marks) been speedy, natural labours. When I arrived at the house, the midwifesufficient to provide a statue, which is to be cast in bronze, for each of the told me that for the past two days the woman had profuse hemorrhage,two cities.

,

and gave me her opinion that it was a case of placenta previa, but she was.

too frightened to do anything. I at once proceeded to make an examination.Dr. Fegan.-We believe one of the parties was referred to in our Corre- I found the bed saturated with blood and a great deal of clotted blood. Onspondence columns of Nov. llth. making an examination per vaginam, the os was pretty well dilated, and I

felt part of the placenta overlapping the os. The woman was all this timePLACENTA PRÆVIA. in a very feeble condition. Being alone I did not care to operate, for fear

To the Editor of THE LANCET. that, should anything happen, all the blame would rest on me. I was placedTo the Editor of THE LANCET. in a very precarious condition, so that I at once gave a full dose of ergotSIR,—Apropos of the letter of "H. P:’ in your last issue, regarding his (which seemed to arrest the hæmorrhage for a short time), and sent for

case of placenta previa, will you allow me to mention a few cases, with the assistance. The doctor who came, alter seeing the case, would not operate,but went off for Dr. Keiller, of this city. Being left again to my own re-treatment adopted, one recently with ver similar results to your corre- sources, and the bleeding having come on again, I determined to take the

13pondent s. risk upon myself and operate : so I at once introduced my hand, usedOn the 10th November last, about 6 r.M., I was sent for to attend a manual dilatation, and removed the placenta first (as the foetus was dead by

woman who had several times sent for me during the month previous, this time), and then gently insinuated my whole hand into the uterus, andstating that she had a show, with pains, and supposing her labour was performed version. At this juncture Dr. Keiller opportunely arrived, andcoming on. On my arrival, the nurse stated she was obliged to send took the responsibility off my hands. The woman, however, died, in spitefor me on account of the severe loss which had happened three times of our endeavour to restore her.that day-first at 9 A.M., then at 2 P.M., and again more severely at In conclusion, I have to add that I have much pleasure in informing youthe time she sent for me. I found the patient very blanched and faint, that I had Dr. Keiller’s approbation for what I did.occasionally swooning from the rapid loss. I would not, however, allow her Yours obediently,to be roused, considering the fainting would tend to diminish the loss, but Edinburgh, Dec. 2nd, 1876. J. C. A., L.M.contented myself with giving her ice freely to suck. On examination I found

District Medical 0fficerthe os dilated to about the size of a florin, but hard and unyielding, so that District Medical Officer.—Our correspondent does not state from whom hespeedy dilatation, even by means of Barnes’s bags, would have been difficult. has received the forms for returns of cases of infectious disease to whichI therefore resorted to Simpson’s method of detaching the placenta from he refers. The Board of Guardians can call for such returns, and putthe cervix, bearing in mind Dr. Barnes’s very able and explicit rules in re- them at the service of the medical health if they think fit.ference to the cause of arrest of hemorrhage by that means. I separated them at the service of the medical officer of health if they think fit.the placenta from its attachment in a zone as far as my finger would easily J. B.-Kingston-hill would probably suit.teach, and found that on each subsequent pain the hemorrhage, althoughnot entirely, was very much diminished. Again passing my finger all round, REYNOLDS SYSTEM OF MEDICINE.I found a portion in the same circle not entirely detached, which I at To the Editor of THE LANCET.

once I was enabled to that time the bleeding almost entirely stopped, so giR.-Will you have the kindness to inform me, through the medium ofthat I was enabled to allow nature to have her course and the patient to your colnmns, what are the prospects of Reynolds’s System of Medicinerally. frequent of they had of ergot, the pains did not become stronger or being completed, and when the fourth volume is likely to appearmore frequent than they had been. At the expiration of three hours after- wards the patient became restless and anxious. Finding the os the size of a Toronto, Nov. 13th 1876

° &c., J. H. C.crown-piece, soft and yielding, I proceeded to deliver. Having gently

passed my hand into the vagina, with the point of my finger I made a hole H. B., (Moseley, near Birmingham.)-We cannot undertake to give advicethrough the placenta within an inch of insertion of the cord, which I tore H. B.(Moseley. near Birmingham )—We cannot undertake to give advicethrough to the edge of the membranes. The uterus quickly contracting, I in the matter, and suggest that our correspondent should be guided byonly managed to get hold of one leg, which perhaps somewhat delayed the that of his usual medical attendant.delivery of the body. As soon as the arms were expelled, I at once appliedthe forceps, and quickly brrought into the world a fine child, apparently A CIRCULAR."

about 10 lb. in weight. It, however, showed no signs of animation., and WE have received rather a long letter from Mr. Pitts, in which he urgesI failed to restore it, although it was evidently alive when I got the leg that the issue of the Circular was a matter of necessity, and goes ondown. The mother, a small and not very strong woman, has made an that the Issue of the Circular was a matter of necessity, and goes onexcellent recovery, to say :-In a practice extending over nearly twenty-four years I have met with " For your information I will state that Mr. Giddings conducts a similar

nine cases of complete placenta prævia. In four of the cases I have adopted branch practice close to my entrance gates at Pudsey.a similar course to the above, and each time with the result of arresting "With regard to my notice in a local paper, the reason why I insertedthe hemorrhage. In one of the four cases, however, the case in which the

B it was, that every time I went out I was told that I had sold my house,

loss was the most severe, after having separated the placenta from its and was about to leave the neighbourhood. It was to correct this rumour,attachment, as described, and during a sharp pain, I happened to detach a I and not with a view of advertising, that I inserted the notice; and underfurther portion beyond the circular line of detachment which I had first similar circumstances I should do the same again."

846

UNQUALIFIED ASSISTANTS.WE have received several communications with reference to unqualifie

assistants, all of which ptjint to the necessity of the most careful itquiries being made before concluding engagements.

.Dr. f. Cockle is thanked.

Mr. Worger.-We should be running some risk to mention so many namein such a connexion.

ASSOCIATION OF SURGEONS rxzecxxaxxa DENTAL SURG3A7r.’

To the Editor of THE LANCET.

SIR,—In your report of the last meeting of the above Society, it will binferred that I totally deprecate the practice of "lancing the gums" of infants when teething. Such is not the case. The gist of my remarks pointe(to indiscriminate lancing when no symptom af an erupting tootlz could b,

found. On the other hand, I mentioued that immediate relief was frequently given by lancing when any sign an af tension or inflammation could b,detected. Your attention to this little e error will greatly oblige,

Yours faithfully,Edgar-buildings, Bath, Deo. 2nd, 1876.

Yours faithfully CHARLES GAINE.MEDICAL COLLEGE, EpsoM.

THE following letter has been addressed by a Foundationer to the Councilof the Royal Medical Benevolent College, Epsom :-

"GENTLEMEN,—My desire in writing to you is to express the deepsense of gratitude I feel and owe to Epsom College, and particularly tcDr. Carr, and the supporters of the Carr Scholarship.’" The last four years of my school days were spent at Epsom as a Foun-

dationer, and while there I received an education enabling me to pass wellthrough the London University Matriculation. I was then fortunateenough to obtain the’ Carr Scholarship,’ a scholarship instituted by thebenevolent and kind heart of Dr. Carr, that has enabled me to obtain aqualification (M.R.C.S.)

- "I strongly, and very favourably contrast my position and chance inlife now with what it might have been had it not been for Dr. Carr andthe College, and by this you may judge of my appreciation of the benefitsreceived." Will you do me the honour to add my name to the list of life governors

of the said College, and accept the sum enclosed of ten guineas." I am, dear Sirs, very faithfully yours,

"University College, Nov. 25th 1876." —

COMMUNICATIONS not noticed in the current number will receive attentionin our issue of the ensuing week.

COMMUNICATIONS, LETTERS, &c., have been received from-Dr. G. Johnson,London; Mr. Jonathan Hutchinson; Mr. John Marshall; Mr. S. Gamgee;Mr. Aveling, Clapton; Dr. Taylor, Southwark; Mr. Menteith, Calcutta;Mr. Habgood, London; Dr. De Fargue, Godalming; Mr. Thornton, London;Dr. Reid, Agra; Dr. Bysack, Calcutta; Mr. Milledge, Newport (Isle ofWight); Dr. Hughes, Ombersley ; Mr. Orton, Newcastle; Mr. Gaine,Bath ; Mr. R. Harris, London; Mr. Boddy, Camberwell-road; Mr. Berry,Wigan; Mr. Johnson, Boyton; Dr. Mobritz, St. Petersburg; Mr. Osborne,Woodhall Spa; Dr. Tibbits, London; Mr. Stott; Mr. Lownds, Walker-on-Tyne ; Mr. Fairbank, Alders hot ; Mr. Bothwell, Leighton Buzzard;Dr. G. Mundie, Eastbourne; Mr. Garland, Yeovil; Mr. Allen, Spithead ;Dr. De Renzy, Arthurstown; Mr. F. A. Allen, London; Mr. Coombs,Lower Ince; Dr. Brietzcke, Portsmouth; Mr. Wilson; Mr. Smith;31r. Robertson; Mr. Doran; Dr. Brown,_ Rochester; Mr. Sutton, Gains-borough ; Dr. Naylor, Winterton; Mr. Williams; Mr. Anderson, Car-marthen ; Mr. J. W. Taylor, Headington ; Mr. O’Reilly, Bermuda;Mr. Duncan, Glasgow; Mr. Griffith, Ravenglass; Mr. Chapman, Edin-burgh ; Dr. Bery, Paris; Dr. Arnison, Newcastle-on-Tyne; Dr. Fox,Chelmsford; Mr. Hawkes, Birmingham; Dr. Storer, London; Mrs. Wall;Mr. Regan, Cork ; Mr. North; Mr. Barnes ; Mr. Custance; Mr. Hardy ;Mr. Larkin; Mr. Burt, Southampton; Dr. Elliott, Hull; Dr. Leeson;Mr. G. H. Healy, Bootle; Mr. Adams; Dr. Austin, Tongue; Mr. Gurner;Mr. Davies, Wrekenton; Dr. Leys, Edinburgh; Mr. Brown, Ventnor;Mr. H. James, Edmonton; Mr. Chapman, Coldstream; Mr. C. Edwards,Hampton; Mr. Whitford, London; Mr. Irvine, London; Mr. Angove,Great Yarmouth ; Mr. Brewer; Dr. Oughton, London; Mr. Wright,London; Dr. Fegan, London; Mr. Favé, Brest; District Medical Officer;A Resident B.A.; A. B. C.; Another Militia Surgeon; H. B.; The

Registrar-General of Edinburgh; Vigilant; Alpha; L. L., Leeds; .G. G.;J. B. ; Constant; Gradatim; &c. &c.

LETTERS, each with enclosure, are also acknowledged from --Yr. Dunston,Strefford; Dr. Kirkman, St. Leonard’s; Mr. Grace, Kingswood-hill;Dr. Poulton, Aramas, Queensland; Mr. Loll, Agra, India; Mr, Dixon,Yarm; Dr. Welphy, Cork ; Mr. Hale, Chesterfield ; Mr. Wardrop,Preston; Mr. Marley, Padstow; Mr. Kerbey, Weobley; Messrs. Abbottand Co., London; Mr. Cotton; Mr. Roocroft, Wigan; Mr. Wilson;Dr. Jones, Llansilin ; Dr. Crane, Broseley; Dr. Atkinson, Bampton;Dr. Bell, Hull; Public Health; A. B. C., Dublin; R. N., Poplar; M. D.,Newcastle-on-Tyne; Hernia; X. Y. Z.; Matron; B. ; M. D., Heath- I,field; B., Otley; C. F., Norwich; Medicus, Wirksworth; Investigator,Melton; Gamma; Locus, Cobham; R. F. A., Edinburgh; W., LowerClapton; W. H. H., Newcastle; Delta, Sheffield; Medicus, Bradford;A. M. D., Brook Green.

Western Morning Neim, Record, Lakes Chronicle, Carnarvon Herald, New-castle Chronicle, Hexham Herald, Manchester Guardian, LiverpooL Poat,Greenock Telegraph, S’outh Wales News, Glasgow Citizen, Western DailyMercury, Dudley Herald, Tunbridge Wells Gazette, East London Obse-rver,and lYorth Britiah Daily Mail have been received.

METEOROLOGICAL READINCS

(Taken daily at 8 a.m. by Steward’a Instrument.)

THE LANCET Cmics, DEC. 7TH, 1876.

Medical Diary for the ensuing Week.Monday, Dec. 11.

ROYAL LONDON OPHTaaLnslc HOSPITAL, MOORFIELDS.—Operations, 10½ A.M., each day, and at the same hour.

ROYAL WESTMINSTER OPHTHeLnrIO HOSPITAL.—Operations,1½ P.M. each dayand at the same hour.

ST. MARK’S HOSPITAL.-Operations, 9 A.M. and 2 P.M.! METROPOLITAN FREE HOSPITAL.—Operations, 2 P.M.MEDICAL SOCIETY OF LONDON. - 8½ P.M. Dr. Ernest Sansom, "On Mitral

Stenosis and Insufficiency." - Mr. Spencer Watson, "On Polypus of theNose"; "Pendulous Tumour of the Tongue."-Mr. Lennox .Browne:Warty Growth from the Uvula"; " Aural Polypus :’

Tuesday, Dec. 12.Girv’s HOSPITAL.-Operations, 1½ P.M., and on Friday at the same hour.WESTMINSTER HOSPITAL.—Operations, 2 P.M.NATIONAL ORTHOPAEDIC HOSPITAL.-Operations, 2 P.M.WEST LONDON HOSPITAL.-Operations, 3 P.M.ROYAL MEDICAL AND CHIRURGICAL SOCIETY. — 8½ P.M. Mr. Hulke, " On a

Case of very general Telangiectasis on the Left Half of the Body, withAbnormalities in Large Bloodvessels of Lower Limb, &c."-Dr. WickhamLegg, " On Haemophilia complicated with Multiple Nt6vi" (two cases).

Wednesday, Dec. 13.MIDDLESEX HOSPITAL: Operations, 1 P.M.ST. MARY’S HOSPITAL.—Operations, 1¼ P.M.ST. BARTHOLOMEW’S HOSPITAL.—Operations, 1½ P.M., and on Saturday at the

same hour.ST. THOMAS’S HOSPITAL.—Operations, 1½ P.M., and on Saturday at the same

hour.KING’s COLLEGE HOSPITAL.—Operations, 2 P.M., and on Saturday at 1½ P.3t.GREAT NORTHERN HOSPITAL.-Operations, 2 P.M.UNIVERSITY COLLEGE HOSPITAL.—Operations, 2 P.M., and on Saturday at

the same hour.LONDON HOSPITAL.—Operations, 2 P.M.SAMARITAN FREE HOSPITAL PoB WonrEx AND CHILDBEN.-Operationa,2½ P.M.HUNTERIAN SOCIETY.—7½ P.M. Council.-8 P.M. Open Meeting.—Specimens

of Joint Disease by Alr. C. F. Maunder; Cases by Mr. Waren Tay.EPIDEMIOLOGICAL SOCIETY.—8½ P.M. Dr. W. R. E. Smart, "On the recent

Appearances of Dengue."

Thursday, Dec. 14.ST. GEORGE’S HOSPITAL.—Operations, 1 P.M.ROYAL ORTHOPÆDIC HOSPITAL.—Operations, 2 P.M.CENTRAL LONDON OPHTHALMIC HOSPITAL.—Operations,2 P.M., and on Friday

at the same hour.Friday, Dec. 15.

ST. GEORGE’S HOSPITAL.—Ophthalmic Operations, 1¼ P.M.ROYAL SouTH LONDON OPHTHALMIC HOSPITAL.—Operations, 2 P.M.MEDICAL MICROSCOPICAL SOCIETY. - 8 P.M. Mr. C. H. Golding Bird, " On

Rodent Ulcer."

Saturday, Dec. 16.ROYAL FREE HOSPITAL.—Operations, 2 P.M.CHARING-CROSS HOSPITAL.—Operations, 2 P.M.

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