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recreation, the blind in America furnish the best musicalteachers, as in France they furnish the best and most suc-cessful tuners. In both countries they earn what may beconsidered handsome incomes, and are enabled to becomeindependent and self-respecting members of society; whileonly those who have no musical faculty are left to engagein brush-making and similar trades. On all these points,and on many others connected with the subject, much inter-esting information may be obtained from a little workwhich Dr. Armitage has lately published,* and to which wemust refer those who are anxious for further particulars.One important point, however, may still be noted. By

the aid of a writing frame, which it has required muchingenuity and patience to render perfect in all its details,the blind can themselves impress the Braille character uponpaper with perfect accuracy, and so use it as a means of

holding written communication with each other, or withany sighted correspondents who will overcome the slightdifficulty of learning to decipher it. The written characterthus made is undistinguishable from that which is printed;and the convenience of the two being thus identical is verygreat. The dots are made by pressing upon the paper bya blunt awl, guided by certain holes in the frame; and thehollows thus made are felt as prominences on the other sideof the paper. Nor is the method confined to paper only.Perhaps its greatest advantage is that it permits the mul-tiplication of plates from which books in raised charactermay be printed, since this process is brought within thereach of any blind person to accomplish for himself. Insteadof paper, a sheet of very thin brass is placed in the writingframe, and is indented by the awl in the ordinary way.The finished metallic sheet is backed up by a compositionconsisting of Portland cement and glue, and it then formsa stereotype plate, from which paper facsimiles of itself

may be printed by simple pressure. Every intelligent blindperson may in this way prepare plates which will increasethe supply of literature available for all who are in likemanner afflicted; and the process can hardly fail to beadopted by the blind as the favourite occupation of theirleisure. The materials are cheap; the labour is extremelyeasy; it admits of being taken up and laid down at anytime; and it is perfectly cleanly, so that it may be done bya lady in a drawing-room. There can be no doubt, we think,that by its means the store both of books and of music avail-able for the blind will soon be largely augmented.In the department of the Exhibition to which we have

referred there will be found many examples of writing andprinting by Braille’s method, as well as by those which theBraille seems likely to supersede. There will be found alsosome excellent specimens of industrial work in both theheavier and the lighter articles of blind manufacture.

REPORT ON VACCINO-SYPHILIS.

THE following are the cases (of the first series reportedon April 25th) which the Committee have had an opportu-nity of seeing through the courtesy of Mr. Hutchinson :-

Vaccinifer No. 1, female, aged seven months. Had beenused on February 7th for vaccinating the series of cases re-ported by Mr. Hutchinson on April 25th. This child ishydrocephalic; its head is much elongated and widenedposteriorly; the fontanelle is somewhat more open thanusual. It is pallid, but not unhealthy-looking. There arefive marks on the left arm from vaccination, which are quitehealed. No eruption can be seen anywhere ; the arms andgenitals are quite clear, but the mother states that therewere sores on the latter after vaccination. The glands inboth groins can be distinctly felt. The mother is ratherpale, but looks healthy, and declares she has always beenso. This is her first child.The following persons were vaccinated from the preceding

case on February 7th, and presented on May 16th the fol-lowing features.

1. Female, aged seventeen, a hearty, robust, plump girl,with bright colour. Has three vaccination marks on theleft arm in a horizontal line, the outer of which is not yethealed. The base of this sore is very slightly thickened.

* The Education and Employment of the Blind. London; Hardwicke.1871.

Mr. Hutchinson states that this girl has been living at homewith her friends, and taking her medicine very irregularly.

2. Male, aged eighteen, assistant to a stationer in West-minster. A dark-complexioned, strumous-looking lad. Hasthree cicatrices on his left arm, which present nothingdifferent from recent vaccination marks. There are a fewsmall scattered spots of acne on the shoulders and upperpart of chest.

3. Male, aged nineteen, a warehouseman in the City, a.

healthy-looking lad. Has an unhealed ulcer, larger than ashilling piece, on the right arm, resulting from vaccination.The sore is covered by a crust, which is disposed to scaleslightly, and its base is leathery. Nothing else can be de-tected.Mr. Hutchinson states that this is the last case traced of

the series related on April 25th, and therefore treatmentwas commenced later than in the others. He also informsus that in the above three cases the vaccination sores allhealed, and subsequently ulceration set in at some of them,which continued to spread slowly until mercury was given;.when in about ten days they commenced to heal. Blackwash was applied locally. The same sequence of eventsoccurred in all the other cases of this group.From the foregoing account it will be seen that neither

the vaccinifer, nor any one of the three cases vaccinatedfrom it, presented any symptoms of constitutional syphilisat the time of our examination. But whilst in case No. 2the vaccination sores were healed, leaving nothing but theordinary scars, in cases Nos. 1 and 3 there were still openulcers at the site of the vaccination fourteen weeks afterits performance. These ulcers were of a suspicious, but,not of a conclusive, character.Of the second series reported by Mr. Hutchinson in an

appendix on May 9th, we have seen the vaccinifer No. 2,and three children vaccinated from it.

Vaccinifer No. 2, male, aged seven months. Had beenused on February 13th for vaccinating the series of casesreported by Mr. Hutchinson on May 9th, and brought underhis observation by Mr. Waren Tay. This child is hydro-cephalic ; its head is universally enlarged; the fontanellesare perhaps more open than usual. It is a pallid, delicate-looking child, and has a slight herpetic eruption on theforehead, but is very lively. It breathes hard through thenose ; the mother says it has a cold, and is teething. Thereis a small white scar at the anus as if from an ulceration.The glands in both groins are large and separate. On the

right arm are five vaccination marks, which are. all healed.The mother is a bright-complexioned, healthy-looking

woman. Has never suffered from illness. This is her firstchild. She has never had a miscarriage, or discharge, orsore nipples. She says the child has been occasionallynursed by the landlady and her children. She knows thatone of these was ill, and sent to Croydon for its health, and!that the mother had attended a hospital in the Hackney-road, but she never heard what was the matter with eitherof them.The father, aged twenty-seven, cabinet-maker, is a spare,.

pale man, but apparently in health. He had workedthirteen years in the same situation. He denies having hadvenereal disease of any kind, and readily submitted to ex-amination without previous preparation. Nothing could befound except some enlarged separate glands in the leftgroin, and a slight white scar on the inside of the cheekopposite to the left molar tooth. The only illness he hasever had are measles and whooping-cough.The following cases, which had been vaccinated from

vaccinifer No. 2 on Feb. 13th, presented the appearances-detailed below on May 16th-thirteen weeks afterwards.

1. E. T-, aged four years and a half, female (No. 2 inMr. Hutchinson’s second appendix). A pallid, thin, strumous-looking child. On the right arm are two sores covered bycrusts. The larger of these has a circumscribed thickenedbase, which is superficial, and has a leathery feel whencompressed; the surface of this is disposed to scale. The

glands in the corresponding axilla are enlarged. There isa scaly eruption, consisting of small, circumscribed, for themost part circular spots, of a copper colour, at the back ofthe neck, the lower part of the abdomen, and the upper and

’ outer part of the thighs; with a general scattered mottlingof the trunk, on its anterior surface especially. The in-guinal and post-cervical glands are large and distinct. Boththe tonsils are excavated, but not now ulcerated.

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2. A. E. T- aged eighteen months, male (No. in Mr.Hutchinson’s appendix). A fat, well-grown, hearty-lookingboy. On the left arm are two large dusky-coloured marksof vaccination, which are scaling on the siirface, but notulcerated; these have a thickened base precisely similar tothe preceding case. There is a general mottling of thetrunk, which is fading, and a few small scaly spots re-sembling those in foregoing patient, and scattered over theabdomen. The glands in each groin are very distinct.There is well-marked ulceration of both tonsila.The mother of these children is a healthy-looking woman.

She had not suffered from illness. A rigid cross-examina-tion failed to elicit any history of previous syphilis in her-self or either of her children.

3. W. C-, aged ten, male (No. 3 in Mr. Hutchinson’s z,

appendix. This case was not reported at the Royal Medicaland Chirurgical Society). A spare lad, but not unhealthyin appearance; his mother says he has lost flesh lately. Onthe left arm the cicatrices of vaccination in infancy showplainly, and below these are two large sores covered withcrusts, with well-defined thickened circumscribed bases,surrounded by a dusky areola. The glands in the corre-sponding axilla are enlarged. The inguinal and post-cer-vical glands are very perceptible to touch. There is a

scaly eruption, for the most part in small annular patches,over the trunk and limbs, which is fading. On each tonsilis a deep vertical ulcer, with a grey unhealthy surface.The mother is a tall, healthy-looking woman. She has

never had any serious illness, and no history of previoussyphilis in herself or her boy could be obtained. Thesethree cases were vaccinated on the same day, and the ulcersresulting have never healed, but have slowly increased insize. There has been no treatment in any of them.In our opinion these three cases present unequivocal evi-

dence of constitutional syphilis, and we see no reason todoubt, from the appearances presented by the arms, andfr0m the history of the cases, that the disease had beenconveyed by vaccination.As to the method in which vaccination was performed in

these cases, and the character of the fluid inoculated,whether lymph, blood, or both, we could obtain no satis-factory evidence, and with regard to this question we mayrefer to the remarks made by Mr. Hutchinson in the ap-pendices to his paper, where such facts as could be elicitedare recorded.

(Signed) SAMUEL WILKS, CsEO. G. GASCOYEN,WM. S. SAVORY, THOMAS SMITH.

The following case was shown to Dr. Wilks by Mr.Hutchinson on May 19th, being one of the second series.

4. Female, aged fourteen (No. in Mr. Hutchinson’ssecond appendix). There was a round red sore on the arm,raised and granulating. Over the body and arms was awell-marked eruption of bronze-coloured, scaly, raised spots.The tonsils were swollen, and slightly ulcerated.

, (Signed) SAMUEL WILKS.SAMUEL WILKS.

HOSPITAL OUT-PATIENT REFORM.

THE Committee appointed at the late meeting to carryO’.1t the resolutions for reforming the out-patient departmentof hospitals had a conference with the Council of the CharityOrganisation Society on Monday last, when it was resolvedthat the Council should co-operate with the Committee, andaccompany a deputation to the President of the Poor-lawBoard. The Committee also invited Dr. Stewart, the secre-

tary of the Metropolitan Branch of the British MedicalAssociation, and Dr. Rogers, of the Poor-law Medical

Officers’ Association, to accompany the deputation.At the interview with Mr. Stansfeld, Sir Charles Tre-

velyan opened the proceedings, and gave a history of themovement. He drew attention to the extremely valuablereports issued by the Committee on out-patient reform, andsaid that the one on General Hospitals was drawn up onthe soundest principles, and was highly honourable to theprofession from which it emanated. The deputation askedfor the assistance of the Poor-law Board on the ground thatthere should be no systematic gratuitous medical reliefwhich was not under the control and supervision of the

Poor-law authorities ; and that it was most important thatthe Poor-law medical relief should be greatly improved.

Dr. Stallard, after giving a history of the out-patientsystem, which he said had grown to its present magnitudein consequence of the shortcomings of the Poor Law, drewattention to the recommendations of the Committee forthe improvement of the Poor-law medical relief. Whilstadmitting that great improvements had been effected, andmany very well managed dispensaries had been recently in-troduced, there was still very much remaining to be done,and the Committee asked the President to put such anamount of pressure upon the guardians as to induce themto carry out the Metropolitan Poor Act uniformly through-out the metropolis. He thanked the President for havingalready fulfilled one of the recommendations of the Com-mittee by issuing regulations for the government of thesedispensaries; and they hoped he would adopt another byplacing them under the charge of a special inspector, whoshould be authorised to visit them regularly, and rpport toParliament annually as to their efficiency. Such inspectorswould act as educational agents to the guardians, andobviate the necessity of putting any objectionable centralauthority in force. He further pointed out that the Com-mittee did not wish to put all gratuitous medical relief underthe Poor Law with the object of extending it to any classwhich ought to be called upon to pay for it; but rather toprevent persons from obtaining gratuitous assistance whowere able to pay, the Poor-law authorities alone havingthe necessary machinery of investigation. The Committeefurther offered to the President a line to determine whowere destitute, for if a man could not contribute a pennyper week to a provident dispensary, he was undoubtedly ina position to require gratuitous relief.Addresses were made by Mr. Timothy Holmes, Dr. Stew art,

Dr. Rogers, and Dr. Hawksley. Dr. Stewart gave his expe-rience as to the pauperising tendency of the present system.He suggested that this manufacture of paupers must be amatter of deep interest to the President of the Poor-lawBoard, and that the hands of those engaged in reformingit would be greatly strengthened if the President would askthe governing bodies of the hospitals and dispensaries forinformation, and express his opinion on the matter in Par-liament or otherwise.

Mr. Stansfeld, who expressed himself as greatly obligedto the deputation for laying the facts he had received beforehim, said he was most desirous of meeting with members ofthese societies for the purpose of discussing these questions.He was convinced of the evils of which they had spoken, andhe well knew the value of voluntary efforts in aid of thelegal or regular forces in lessening those evils. Theiropinion, as he gathered it, was that there should be no gra-tuitous medical relief, except under the Poor-law Board.The Poor-law Board could not control the free action ofinstitutions supported by voluntary subscriptions, and thiscould only be done by appealing to the public, and by in-fluencing the organs of public opinion to stop such evilsby exposing their dangers. He stated that the Poor-lawBoard was proceeding to urge forward the dispensarysystem in town, under the Act of 1867, and even in thecountry, where the board had no power of enforcing itsviews on this point as yet, the system was being adoptedby guardians, whom he had found generally willing totake advice. Speaking of a proposed "general system,"he expressed his confidence in a local rather than in acentralised system, and he thought that, though local actioncaused delay sometimes, yet that, on the whole, it workedbetter than the over-ruling and over-governing found in acentralised system. He quite agreed as to the necessity ofthe provident dispensary system, but said it rested with thepublic.The deputation thanked Mr. Stansfeld and Mr. Hibbert,

M.P., for their attention, and withdrew.

DINNER TO MM. RICORD AND DEMARQUAY.

ON the 17the inst. a most touching demonstration tookplace at Willis’s Rooms-a demonstration which does con-siderable credit to the élife of the profession of London,and which must have been most gratifying to the eminentmen who were the subjects of the cordial welcome bestowed