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Whilst admitting with Dr. Finlay that the murmur ofmitral regurgitation was frequently heard at the inferiorangle of the scapula, he had also heard there the murmurwhich other observers had spoken of as presystolic. He

thought that the conduction of the murmur to the angle ofthe scapula depended upon the volume of blood that wasregurgitating through the mitral orifice.Owing to the length of the discussions, Dr. Mantle’s paper

on Traumatic Tetanus and Dr. Limont’s paper on Adenoid

Vegetations of the Pharynx were taken as read.

Notices of Books.St. Thomas’s Hospital, Southwark. Part 2. By W.

RENDLE, F.R.C S. (Reprinted from the Transactions of theRoyal Society of Literature.)-This interesting pamphlet isa continuation of " a short sketch history of St. Thomas’sHospital in Southwark, from about A.D. 1200 downwards,chiefly from original manuscripts,’’ which we were able tonotice favourably at the time of its publication a fewyears ago. The hospital seems to have borne severalnames. Mr. Randle says-" I may note the changes,according to the whim of the time, in the name of ourhospital. The Hospital. of St. Thomas Overy-that is,of Thomas of Canterbury, ;less respectfully Bekket’sspyttell’; the Hospital of the Holy Trinity; speedilychanged, out of compliment to the generous re-founder,Edward VI., to the King’s Hospital; and finally, and as it isnow, the Hospital of St. Thomas the Apostle." Here is a

picture of a hospital staff more than three hundred yearsago: "In 1571 a ’phesyssion,’ Mr. Bull, is appointedat a salary of twenty marks by the year, and to have ahouse in the Close; he acts as general doctor, superintendsthe apothecary and his drugs, but professionally is in aposition subordinate to an official governor who has no

pretence to a knowledge of medicine. The surgeon is atthis time not much more than a curer of sore heads and amender of broken bones, and has for competitors outsiders,curers.of sore heads and bone-setters. The surgeon, as we

see, works under the pressure of having his unsuccessfulcases handed over to them, who if they cure are paid-anearly instance of the no cure, no pay’ system. In 1632 the

apothecary is side by side with a herb-woman who has £4 a

year for physical herbs. In 1652 a midwife is paid 2s. 6d.for her help to two poor women; long before Mother Edwynengages to cure a boy of hernia for 13s. 4d., half of whichshe will return if she fails." The surgeon comes in the listof officers between the shoemaker and the barber, and evenin 1647 was not allowed to prescribe medicine, that functionbeing restricted to the physician, who, however, in commonwith his surgical colleague, appears to have been consideredas of infinitely less importance than not only the treasurer,but the cook, the butler, and the shoemaker !Four Months among the Surgeons of Europe, being a series

of letters to Dr. Chr. Fenger. By N. SENN, M.D., Ph.D.,of Milwaukee, Wis.. Chicago. 1887.-These letters were

originally published in the columns of the journal of theAmerican Medical Association, but they are well worthy ofbeing reprinted in a separate form. They describe in a

brief and pithy way what Dr. Senn saw in a four months’tour among the surgeons of Europe, and they are veryuseful as affording a picture of contemporary surgery.Dr. Senn is evidently a keen critic, but not an unkindlyone, and his judgments are not warped by preconceivednotions, by prejudice, or by the dictates of authority. Atone time we find him speaking enthusiastically of a youngand unknown worker, and at another running away fromThiersch because he had nothing to teach him. Dr. Sennwas evidently not greatly impressed with :London surgery,and he gives a painfully detailed account of an operation

he witnessed. But it is only fair to add that Dr. Senn didnot devote sufficient time to London, and he did not visitseveral of the principal hospitals, or meet many of the

leading surgeons. The letters are very frank, written as

probably only an American enjoying a "good time" couldwrite them, and readers will get many a laugh from them.

Alassio: a Pearl of the Riviera. By Dr. JOSEPH SCHNEER.Pp. 80. London: Tnibner and Co. 1887.-The author statesin the introduction that his sole desire is to attract to this" Pearl of the Riviera" the attention of those who seek, farfrom the noise and bustle of the great world, a peacefulretreat amid lovely and romantic scenery. The booktherefore is mainly a guide to Alassio, giving its history fromthe earliest periods, a description of its present condition,and an account of the various charming and easy excursionswhich may be made from it. The only specific informationrelating to its climate is contained in five pages of meteoro-logical observations. It is, as we know, a beautiful spot,but there is little said of its sanitary condition, which, wefear, is not up to the mark. On the important subject ofwater the author remarks: "There is still much to be donein Alassio for the provision of a proper supply of water.Spring water is only to be had at particular spots, and theinhabitants have to content themselves for the most partwith pumps. Financial difficulties have hitherto stood inthe way of the laying down of pipes in order to bring aproper supply of water into the town."The Influence of Sex in Disease. By W. ROGER WILLIAMS,

F.R.C.S., Surgical Registrar to the Middlesex Hospital,Surgeon to the Western General Dispensary. London:J. and A. Churchill.-Mr. Williams has in this little work

brought together a number of facts collected from the

reports of the Middlesex and other hospitals bearing on theinfluence of sex in disease. He has compiled tables showingthe diseases which affect each sex specially, in which thediseases are arranged in the order indicating relative

liability. The table of female affections begins with thoseof the generative system and ends with phthisis, while thecorresponding table for male affections commences withstricture of the urethra and ends with apoplexy. Regardingtyphoid, the late Dr. Murchison believed the sexes equallyliable, but, according to Mr. Williams, more males thanfemales are attacked; on the whole, however, more femalesdie, they being more liable to the accident of perforationthan men.

Too Curious. A Novel. By EDWARD J. GOODMAN.London: Richard Bentley and Son. 1887.-The late JohnStuart Mill foresaw the day when music would cease to becomposed, as every possible combination of sounds had

already been put together. In like manner certain criticsof the " present state of the novel " are recommendingyoung authors to try romance, as the novel of real life isdying of inanition from the exhaustion of its materials." Too Curious " is Mr. Goodman’s answer to these gentlemen.He has shown that, by making no greater demand on thecredulity of his readers than others of his contemporaries,he can construct a fresh and interesting novel of real lifefrom the people and the events that live and move

around us. For the medical public " Too Curious" hasspecial interest, not only for its sketches of hospitalinteriors and of every-day practitioners-Dr. Redmond isa character in point,-but for the happy use it makesof the phenomena of disease, especially of hysteria and

catalepsy. Let any of our prolific young novelists do asMr. Goodman has done-make a study of pathology as itaffects real life,-and a whole world of interesting " develop-ments" in character and situation will be revealed to himfor the exercise of his flagging invention. We are not

going to unravel the plot of "Too Curious." We shall havedone enough if we have sent our readers to a novel ofcontemporary life which touches at many points on the

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profession and its subject-matter, and which is not only ofkeen interest as a narrative, but is written in a flowing andgraceful style which enhances the pleasure of its perusal.

Illustrations. Edited by hn,Artcrs G. HEATH. London:W. Kent and Co.-This volume, as one of the books of theseason, is worthy of praise. The engravings, as a whole, arereally excellent, whilst the articles are undeniably soundand good. It is not easy to conceive of a more fitting new-year’s gift than this book would prove to an intelligentjuvenile of either sex, and persons of more mature growthmight well occupy a little leisure in scanning its pages.

ANNUAL REPORT OF THE MEDICAL OFFICEROF THE LOCAL GOVERNMENT BOARD.

SECOND NOTICE.]RECALLING the circumstance that the subject of scarlatina

and its relation to disease in bovine animals, which forms animportant part of Dr. Buchanan’s last report, was largelydealt with in our issue of Dec. 17th in connexion withDr. Klein’s and Professor Crookshank’s papers, and remind-

ing our readers that the discussion on the subject at theEpidemiological Society will take place on January llthnext, we pass over that portion of the present report whichdeals with that subject and go on to advert to some of theother more purely scientific labours that are recorded in thevolume.The subject of tubercle has long been one which demanded

the closest investigation in relation to public health, andowing to the allegation, during recent years, that the use ofthe milk of cows suffering from tuberculous disease wascalculated to induce that disease in the human subject, ithas become more than ever imperative that the department,having, as a duty, to maintain a general supervision over thehealth of the country and to guide sanitary authorities intheir action, should do all it can to elucidate the circum-stances under which this important infection may be com-municated and spread. On the one hand, we have the seriousfact that a large number of otherwise good milch cows aretuberculous, especially those which are stall fed and arekept in towns; and on the other, the more hopeful aspect ofthe case, that so far there is no evidence of tuberculousinfection in milk itself. Dr. Klein and Mr. Lingard havemade further investigations into the etiology and pathologyot tuberculosis. in the direct inoculation of fowls with both human and bovine tubercle, the results now obtained are Ifound to differ somewhat from those previously recorded.As to human tubercle, the last experiments show that it hasbeen less readily communicable to fowls, and it can as yetonly be suggested that this may be due to a difference ofbreed experimented on. Out of eighteen fowls infectedwith bovine tubercular matter five developed well-markedtubercle; whereas on the former occasion four fowlsexperimented on proved all of them refractory to bovinetubercle. The reversal in this case, too, may perhaps bedue to the fact that the fowls last used were of a differentbreed to those used formerly, and this question of breed raisesconsiderations that will have to be further examined into.Other experiments, made with a view of ascertaining whethertubercular virus by its passage through the fowl undergoes anyand what alteration of virulence, go to show that by its passagethrough the fowl the bovine tubercular virus gains, so far asthe fowl species is concerned, in virulence, fowls becomingmore susceptible to it, and developing it in an exceptionallyshort time. It has also been ascertained that, just as inother constitutional affections the marrow of bones tends tobecome seriously implicated, so as regards tubercle themarrow is the seat of the earliest manifestation of inducedgeneral tuberculosis, the red marrow of long bones of rodentsbecoming affected before any deviation from normal con-ditions can be detected in any of their tissues and organsremote from the point of experimental inoculation. Wehave here an addition to the knowledge which pathologyhas supplied as regards this disease for the purposes ofpreventive medicine, and we find in it a further inducementto proceed with the investigation of an infection which is sowidespread and so fatal in this country.

Dealing with the question of protection against infection

by the agency of fluids in which infective bacteria havegrown, Dr. Wooldridge records that he has obtained a." fibrogen " in which he has grown the anthrax bacillus, andafter having separated the organism from the fluid in whichit has grown, he is able, by introducing this fluid in con-siderable quantity into the venous system of an animal, toprevent the development of anthrax in its virulent formwhen the poison is simultaneously introduced under theskin. In fact, he hopes that he may be able soon to produce-a fluid that can be trusted to furnish with constancy acomplete protection against inoculated anthrax. "Theseresearches on anthrax," writes Dr. Buchanan, " have to beregarded as introductory to observations on the material ofother diseases, and the whole may be expected to be of thehighest practical importance to preventive medicine."

Professor Cash, in continuing the researches as to thevalue of certain disinfectants, and using for his experimentsthe contagia of anthrax and of tubercle, finds, as regardsthe disinfecting abilities of chlorine, bromine, and iodine,that the degree of dilution of the agent and the thorough-ness of the exposure to its influence constitute elements inthe destruction of morbific properties which several virusespossess; and, estimating the relative potency of the severalagents, he finds that the three agents do not show any veryremarkable difference the one from the other, though iodineappears the most, and chlorine the least, potent. Both asregards these substances and sulphurous acid, Dr. Cash findsreason to prefer solutions to gases; but if a disinfectant iea gaseous form is needed, then he prefers that it should besulphurous acid. To one important point in Dr. Cash’sreport Dr. Buchanan desires to give prominence-namely,where he " points out afresh the consideration, too often lostsight of in practice, that, inasmuch as quantity of the dis-infectant counts for so very much in the destruction of anydisease-producing material, it is necessary to take accountof the assimilation, by harmless material, of the agentdesigned to disinfect; wherefore the quantity of the dis-infectant used must be proportioned to the amount of suchother material, as well as to the amount of actual morbidmatter to be destroyed."

Further experiments are in progress by Dr. Klein as to thedisinfection of pathogenic organisms by perchloride ofmercury, he seeking to recognise the limits of attenuationavailable for practical use, so as to give insusceptibility to’animals to whom the virulent infection of anthrax maysubsequently be introduced; he is also extending similarresearches to other bacilli, and to the micrococcus of scar-latina. Research is also being made into the chemistry o5potable waters, with especial reference to the life history oftheir contained organisms; but these, together with certain.related biological observations, are not yet ready for pub-lication.Taken as a whole, the volume under consideration must

be regarded as one of the most important ever issued. Someof the matters dealt with in it, and notably that of metro-politan small-pox isolation, have been brought to a stageat which they need to be dealt with administratively, and a.strong public demand in this direction can hardly fail to’arise, unless the initiative is taken by those who now havethe matter in hand. London must not go on blindlyspending its thousands sterling on these hospitals withoutknowing absolutely and definitely where it is drifting. Thestage reached as to the question of scarlatina and of tuberclein its relation to disease in the lower animals, is also one ofgrave importance to the public health ; and it is clear that,if ever there was a time when the State should prosecutefurther research into the etiology of infectious diseases, itis the present one. The other labours we have adverted tohave a different bearing on the prevention of such diseasesybut the knowledge already acquired is of the utmost import-ance, and it promises the best results in its application tothe promotion of public health. We wish that the Stats’could understand how the prevention of disease would beadvanced by placing this and similar official records inthe hands of all medical officers of health, for it is ofthe first importance that local advisers should be placedin possession of the most recent scientific informationbearing upon the duties they have to perform.

FATAL FOOTBALL ACCIDENT.-While playing on the28th inst. at Aberearne, a football player was struck by theball in the abdomen, and, falling to the ground, imme-diately expired.